Prostate cancer (summary)

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This is a basic article for medical students and other non-radiologists

Prostate cancer, also called carcinoma of the prostate or prostate carcinoma, is the commonest malignant tumor in men. It is primarily a disease of old age and many men remain asymptomatic.

Reference article

This is a summary article; read more in our article on prostate cancer.

Summary

  • epidemiology
    • primarily disease of elderly men
  • presentation
    • elevated PSA without clinical symptoms
    • large prostate on rectal examination
    • urinary symptoms
    • back pain
  • pathophysiology
    • 95% prostatic adenocarcinoma
    • spread
      • local invasion
      • lymphatic spread
      • haematogenous spread
        • bone (90%)
    • use Gleason score
  • investigation
    • ultrasound-assisted prostatic biopsy
    • local and whole-body staging
  • treatment
    • depends on whether there is spread and if the patient is symptomatic
    • options include
      • radical prostatectomy
      • brachytherapy (insertion of radioactive rods into the prostate)
      • external beam radiotherapy

Role of imaging

  • assist in a successful biopsy
  • MR for local staging, e.g. is there extracapsular spread?
  • whole-body staging

Radiographic features

Ultrasound
  • a hypoechoic region in the periphery of the gland
  • ultrasound-guided transrectal biopsy
MRI
  • used for local staging
  • determine whether tumor extends out with the prostatic capsule
  • can be used to guide biopsy if the US-guided biopsy is negative
CT
  • not useful for detection of in situ prostatic cancer
  • can be useful to detect enlarged lymph nodes
Bone scan
  • used for identifying distant bone metastases
Medical student radiology curriculum