Diagnosis of prostate cancer
For the diagnosis of prostate cancer, the most significant are the palpation and the PSA – determination in the blood, which should be regularly noticed as preventive examinations from the age of 45. If the above-mentioned examinations give rise to a suspicion, a tissue sample should be taken in the form of a so-called punch biopsy. In this case, 6 – 12 samples are taken from different areas of the prostate.
The procedure is performed through the rectum and is painless due to the speed of the procedure. Post-operative bleeding is possible, therefore blood-thinning medication (e.g. aspirin) should be discontinued beforehand in consultation with the treating physician. The following examinations are necessary for an exact size estimation of a possibly existing tumor: For further therapy planning, a CT (computed tomography) or MRI (magnetic resonance imaging) of the prostate may be necessary.
In recent years, MRI of the prostate has become more and more important because specially trained radiologists can now make good statements about the location and spread of the tumor. Samples can now also be taken under the MRI of the prostate. In order to detect metastases, a scintigraphy of the skeleton is necessary, since this is where the first distant metastases are usually found (especially in the pelvic bones and lumbar spine).
Learn more about metastases in prostate cancer. If the PSA value is lower than 10 ng/ml, metastases are highly unlikely and a skeletal scintigraphy is not performed. During the subsequent microscopic examination of the tissue removed, the pathologist can determine the degree of malignancy (degree of malignancy) using existing tables (Gleason score, classification according to Dhom). Click here for the main article Prostate biopsy.
- Digital – rectal examination (palpation)
- Transrectal Ultrasound
- PSA – concentration in blood
TNM Classification
The TNM classification describes prostate cancer in terms of the local tumor itself (primary tumor), abbreviated as (T), and the presence of lypmph node metastases (N) or distant metastases (M). The stages of the disease defined here have a direct impact on therapy planning and the prognosis for the patient (cure survival rate).
- T1: Incidental carcinoma (not palpable or visible), i.e. randomly detected in a biopsy T1a – < 5% of removed tissue detected in a scraping of the prostate in BPH (benign prostate hyperplasia) T1b – > 5% of removed tissue detected in a scraping of the prostate in BPH (benign prostate hyperplasia) T1c – larger tumor detected in a trunk biopsy (e.g.B.
for elevated PSA)
- T1a – < 5% of the removed tissue as part of a scraping of the prostate in BPH (benign prostate hyperplasia)
- T1b – > 5% of the removed tissue as part of a scraping of the prostate in BPH (benign prostate hyperplasia)
- T1c – larger tumor detected by strain biopsy (e.g. in case of elevated PSA)
- T1a – < 5% of the removed tissue as part of a scraping of the prostate in BPH (benign prostate hyperplasia)
- T1b – > 5% of the removed tissue as part of a scraping of the prostate in BPH (benign prostate hyperplasia)
- T1c – larger tumor detected by strain biopsy (e.g. in case of elevated PSA)
- T2: Tumor confined to prostate T2a – less than half of a lobe affected T2b – more than half of a lobe affected T2c- Both prostate lobes are affected
- T2a – less than half a lobe affected
- T2b – more than half of a lobe affected
- T2c- Both prostate flaps are affected
- T2a – less than half a lobe affected
- T2b – more than half of a lobe affected
- T2c- Both prostate flaps are affected
- T3: tumor exceeds the prostate T3a – prostate capsule is exceeded T3b – tumor affects the seminal vesicles
- T3a – prostate capsule is exceeded
- T3b – Tumor affects the seminal vesicles
- T4: Tumor affects neighboring organs (bladder neck, sphincter, rectum, etc. )
- N+/N- : lymph node infection in the pelvis janein
- T3a – prostate capsule is exceeded
- T3b – Tumor affects the seminal vesicles
- M0/1: distant metastases no yes
