Prostate Cancer Investigations/Diagnosis Video

Video Transcript:

CancerBro, what are the investigations required to confirm the diagnosis of prostate cancer?

Now we move on to the diagnostic workup prostate cancer.

The diagnostic modalities for prostate cancer are a digital rectal examination, serum markers, prostate biopsy, and imaging.

Prostate-specific antigen or PSA is the biomarker for prostate cancer.

PSA may be falsely elevated in conditions other than prostate cancer.

Most commonly seen are urinary tract infection, bladder catheterization, needle biopsy of prostate and transurethral resection of the prostate.

Normal PSAs levels also vary with the age of a person.

It is less than 2.5 in 40 to 49 years, less than 3.5 in 50 to 59 years, less than 4.5 in 60 to 69 years and less than 6.5 in 70 to 79 years of age.

CancerBro, PSA may be elevated due to so many factors, then how do we know the elevation is due to the disease or other factors?

We can never be 100% sure just based on PSA. It guides us for further investigations and confirms the disease by DRE, biopsy, and imaging.

So to understand it better we come to the free to total PSA ratio.

PSA levels of 4 to 10 are overlapping for benign hypertrophy of prostate and prostate cancer, so free to total PSA ratio will help us to differentiate these two conditions.

If the ratio is less than 10%, it goes in the favor of cancer.

If the ratio is less than 10%, it goes in the favor of cancer.

Next important investigation is a prostate biopsy.

The prostate biopsy may be done under ultrasound or MRI guidance, but the baseline scan should be done as a biopsy may distort the architecture and make it difficult to analyze the scan reports.

Prostate biopsy is assigned a grade called as Gleason’s grade.

For diagnosis of prostate cancer, multiple biopsies are taken from the prostate. In each biopsy sample, we do the Gleason’s scoring.

The scoring is done out of 5, the most common or most predominant score of all the biopsy samples is called as the primary score.

Whereas, the highest score of all the biopsy samples is known as the secondary score.

The total score is calculated by adding a primary and secondary score. The minimum score is 3 in each so the minimum total score is 6.

Score as 6 is called low grade, 7 is intermediate grade and score between 8 to 10 is high grade.

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