TAILIEUCHUNG - Chapter 091. Benign and Malignant Diseases of the Prostate (Part 5)

TRUS is the imaging technique most frequently used to assess the primary tumor, but its chief use is directing prostate biopsies, not staging. No TRUS finding consistently indicates cancer with certainty. CT lacks sensitivity and specificity to detect extraprostatic extension and is inferior to MRI in visualization of lymph nodes. In general, MRI performed with an endorectal coil is superior to CT to detect cancer in the prostate and to assess local disease extent. T1-weighted images produce a high signal in the periprostatic fat, periprostatic venous plexus, perivesicular tissues, lymph nodes, and bone marrow. T2-weighted images demonstrate the internal. | Chapter 091. Benign and Malignant Diseases of the Prostate Part 5 TRUS is the imaging technique most frequently used to assess the primary tumor but its chief use is directing prostate biopsies not staging. No TRUS finding consistently indicates cancer with certainty. CT lacks sensitivity and specificity to detect extraprostatic extension and is inferior to MRI in visualization of lymph nodes. In general MRI performed with an endorectal coil is superior to CT to detect cancer in the prostate and to assess local disease extent. T1-weighted images produce a high signal in the periprostatic fat periprostatic venous plexus perivesicular tissues lymph nodes and bone marrow. T2-weighted images demonstrate the internal architecture of the prostate and seminal vesicles. Most cancers have a low signal while the normal peripheral zone has a high signal although the technique lacks sensitivity and specificity. MRI is also useful for the planning of surgery and radiation therapy. Radionuclide bone scans are used to evaluate spread to osseous sites. This test is sensitive but relatively nonspecific because areas of increased uptake are not always related to metastatic disease. Healing fractures arthritis Paget s disease and other conditions will also cause abnormal uptake. True-positive bone scans are rare if the PSA is 8 ng mL and uncommon when the PSA is 10 ng mL unless the tumor is high-grade. Prostate Cancer Treatment Clinically Localized Disease Localized prostate cancers are those that appear to be nonmetastatic after staging studies are performed. Patients with localized disease are managed by radical surgery radiation therapy or active surveillance. Choice of therapy requires the consideration of several factors the presence of symptoms the probability that the untreated tumor will adversely affect the patient during his lifetime and thus require treatment and the probability that the tumor can be cured by single-modality therapy directed at the prostate or requires .

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