152 - Diagnosis and Staging of Prostate Cancer

Abstract

Prostate cancer rarely causes symptoms at an early stage. The presence of symptoms suggests locally advanced or metastatic disease. Manifestations of locally advanced prostate cancer include obstructive urinary symptoms; ureteral obstruction causing renal failure; hematospermia or decreased ejaculate volume; and, rarely, impotence. Manifestations of metastatic disease include bone pain, pathologic fractures, anemia, and lower extremity edema; less common are malignant retroperitoneal fibrosis, paraneoplastic syndromes, disseminated intravascular coagulation (DIC), and paralysis. Locally advanced and metastatic disease are uncommon presentations because of widespread screening with prostate-specific antigen (PSA) testing and digital rectal examination (DRE). A histologic diagnosis of prostate cancer is typically made by prostate needle biopsy with guidance from ultrasound and/or magnetic resonance imaging (MRI) before any symptoms develop. After a diagnosis of prostate cancer, the goal of staging is the accurate determination of disease extent and risk for management decisions and prognostication. In addition to PSA level and DRE, the pathologic features on prostate biopsy (grade and volume of cancer) help inform management decisions. Imaging studies also may be used during the staging process to evaluate the locoregional extent of disease and/or to rule out metastases.