Prostate biopsy
Digital (DRE) and PSA yield a confirmation
on biopsy of carcinoma 55-63%, with 20% with high grade; PSA alone 22%.
Prostate weighs 20-25 gms until 59 years. 800,000 biopsies annually. Cystic prostate
lesions are common.
All hypoechic lesions should be included. The lack of hypoechoic focus does not preclude biopsy because 39% of all cancers are
isochoric. Other causes for hypoechoic focus include granulomatous, prostatitis,
Prostatic infaret, and lymphoma.
Hypoechoic lesions is malignant in 17-57%
of cases. TAUS findings correlate poorly with pathologic findings and outcome
LHRH causes 30% (10-60% depending on size)
of prostate volume.
Cleansing enema and antibiotics one-day
prior are recommended.
Prostatic block using 2% lidocaine, 5
mL.
Label location of biopsy samples.
The vast majority of adenocarcimomas arise
in posteral PZ.
6 cores were standard, now 8 with a 96%
detection rate (with large prostates more samples yield a + 15% detection). A
second biopsy yield about 5% rate.
Fine-needle aspiration biopsy is used
in many countries outside the US.
Color Doppler is not sufficient accurate
(misses 45%) to permit skipping biopsy; however, it improves biopsy detection.
2% of those who have a biopsy require
hospitalization for infection.
Based on PSA screening, carcinoma rate
of 22-34%.
Among the genes common to prostate cancer
are AMCACR on chromosome 5; P19GSTP1) for glathione S-transferase and ras associated domain family protein isoform A (RASSSFIA0;
…. {chart in book on genes}
There are three proteins that bind PSA. With prostate cancer the ACT binding percentage is higher and thus a lower percentage
of free total PSA.
BPH, prostatitis, and prostate cancers
are the most important factors affecting serum PSA levels.
Deferred treatment is traditional reserved
for men with a life expectancy of less than 10 years and a low-grade prostate cancer.
The section below explains why the excision of the cancerous tissue is preferred when aggressive treatment
is advisable.
PROSTATE
CANCER TREATMENT
The main advantage to radical prostatectomy
is that if it is skillfully performed, it offers the possibility of cure with minimal collateral damage to surrounding tissue. Further, it provides more accurate tumor staging by pathologic examination of the
surgical specimen. Also, treatment failure is more readily identified and the
postoperative course is much more readily identified and postoperative course is much smoother than in the past. Hospital stay is 1-3 days. Moreover, radical prostatectomy
significantly reduces local progression and distant metastases and improves cancer-specific and overall survival rates compared
with watch and waiting. Erectile dysfunction and rectal complications are less
likely with nerve-sparing surgery than with radiotherapy. Other common side effects
include inguinal hernia and urethral stricture.
Approximately half of patients develop
erectile dysfunction after radiotherapy for prostate cancer. This is caused by
injury to the vasculature of the cavernous nerves and to the corpora cavernosa of the penis, usually beginning about 1 year
after the completion of treatment. (p. 2939) Comparisons of radical prostatectomy
to radiation therapy are misleading because of different endpoints—surgery having the longer endpoint.
