Evaluation of the Patient With Prostate Cancer

Ashutosh Tewari, MD, MCh, Badrinath Konety, MD, Akshay Bhandari, MD, James Peabody, MD, Hans Stricker MD, Christine Johnson, PhD, Raymond Demers, MPH, Mani Menon, MD, FACS, the Josephine Ford Cancer Center and Department of Urology, Henry Ford Health System, Detroit, Michigan.

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Current Tests for Evaluation of Prostate Cancer

Many tests and clinical staging tools are currently available, including digital rectal examination (DRE), prostate-specific antigen (PSA), prostate-specific antigen density (PSAD), sextant prostate biopsy, molecular staging (PCR-PSA), microvascular density, endorectal magnetic resonance imaging (MRI), pelvic computed tomography (CT), CT-guided lymph node biopsy, specific monoclonal antibodies, bone scintigraphy, and staging pelvic lymph node dissection. On their own, none of the individual tests can be expected to provide accurate assessment of disease stage. In fact, about 49% of patients with clinically localized disease have disease beyond the confines of the prostate and are thus understaged. Similar inaccuracies are expected in patients being treated by other treatment modalities such as radiation therapy or brachytherapy. Precision in staging can improve the results of various treatments by allowing proper patient selection.

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