Understanding the diagnosis of prostate cancer

Abstract

Summary Prostate cancer continues to be the most commonly diagnosed cancer, and the second leading cause of cancer death among Australian men. Prostate‐specific antigen testing is personalised (not dichotomous in nature) and its interpretation should take into account the patient's age, symptoms, previous results and medication (eg, 5‐α reductase inhibitors such as dutasteride). Multiparametric magnetic resonance imaging of the prostate has been proven to have a 93% sensitivity for detecting clinically significant prostate cancer. It has the potential to decrease unnecessary prostate biopsies by around 27%. International Society of Urological Pathology (ISUP) grade 1 (Gleason score 6) has been shown to have very little, if any, risk of metastasis ISUP grade 1 (Gleason score 3 +3 = 6) and low percentage ISUP grade 2 (Gleason score 3 + 4 [< 10%] = 7) can be offered active surveillance. The goal of active surveillance is to defer treatment but is still curative when required. With better imaging (magnetic resonance imaging and emerging prostate‐specific membrane antigen positron emission tomography–computed tomography) and transperineal prostate biopsy, more men can be offered screening after discussion of risks and benefits, knowing that overdiagnosis has been minimised and radical treatment is reserved for only the most aggressive disease.

Irreversible Electroporation for Prostate Cancer

“…Prostate cancer continues to be one of the most commonly diagnosed cancers in men and a leading cause of cancer deaths in males worldwide [1]. Although it can be lethal in its advanced stage, prostate cancer can be effectively treated when it is localised.…”

“…The last decade has seen a change in management for very low and low risk prostate cancer and an increasing interest in new techniques for the treatment of intermediate risk prostate cancer. Very low and low risk prostate cancer has an unlikely chance of metastasis and a very low risk of mortality [1]. As such, guidelines now recommend treatment with active surveillance to delay or mitigate the need for RP or RT [2].…”

Untitled

“…Screening tests help in diagnosis and treatment the cancer, early or even before symptoms appear [20]. PCa screening is performed based on PSA level measurement, MRI/ ultrasound and/ or CT scan, and finally the results of pathology, in Iran.…”

Modern paradigms for prostate cancer detection and management

“…More accurate staging with prostate‐specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) avoids futile local interventions, and treatment options for localised disease now include active surveillance reducing harms such as incontinence, erectile dysfunction, and radiation cystitis and proctitis. Patient characteristics, including symptom profile, comorbid conditions, and lifestyle, are the central focus when deciding individualised management 5‐7 . Building upon a review published in 2020, 7 this article emphasises the ongoing need for screening with PSA as a critical risk‐assessment tool, highlighting that PSA has become a triage tool for mpMRI, and mpMRI a triage test before biopsy.…”

“…Patient characteristics, including symptom profile, comorbid conditions, and lifestyle, are the central focus when deciding individualised management. 5 , 6 , 7 Building upon a review published in 2020, 7 this article emphasises the ongoing need for screening with PSA as a critical risk‐assessment tool, highlighting that PSA has become a triage tool for mpMRI, and mpMRI a triage test before biopsy. This review explores the latest evidence for PSMA PET/CT for staging of prostate cancer and covers the best evidence‐based management of localised and advanced prostate cancer.…”