DIAGNOSIS OF. PROSTATIC CANCER ; CLINICAL, LABORATORY, TRANSRECTAL ULTRASOtJND ASSESSMENT AND HISTOPATHOLOGICAL STUDY

Abstract

Digital Rectal Examination (DRE) has become 'the classic method for assessing the local extent of prostate malignancy, Although essential, DRE lacks sensitivity and specificity in predicting organ-confined or non-organ-confined disease. If compared with the final pathologic evaluation of the surgical specimen, DRE findings present a false­ negative rate for non-organ-confined disease of approximately 48%, according to several reports. DRE frequently underestimates the extent of disease for prostate cancer, and it is especially inaccurate in the staging of Tlc and T2 prostate cancer, many of which are found to be T3c on final pathology reports. However, in patients with a PSA value of< 4 ng/ml. and a Gleason score of < 7 the presence of nonsuspicious DRE defines a patients population with a high probability of having localised disease. The positive predictive value of DRE for non-organ-confined prostate cancer is good, in other words, when the DRE indicates a T3a or higher prostate cancer, it is most likely an non-organ-confined tumour.

Despite its limitations, the clinical examination and staging of all newly diagnosed prostate cancer starts with a carfully performed DRE. DRE -driven TNM classification of prostate cancer is the logical initial step of clinical staging in all patients. However, due to its lack of sensitivity, specificity, and overall accuracy, it is necessary to combine DRE T-staging with other parameters to improve performance of clinical staging, ultimately resulting in better theraputic planning.

No single staging parameter or test has sufficient accuracy in the prediction of non-organ-confined tumour to be relied on by itself for the individual patient. The most useful and minimally required varuables to be associated with DRE are total serum PSA concentration, Gleason score, and other findings from the systematic prostate biopsy. Partin et al.<262 ) have reported nomogram tables based on total serum PSA, Gleason score, and local clinical stage that provide predictive probabilities for organ­ confined disease, non-organ-confined cancer, seminal vesicle invasion, and lymph node metastases.

Whereas total serum PSA has an increasing important role in many clinical decision support tools to improve the accuracy and cost­ effectiveness of clinical staging, serum PAP testing has no practical value in the routine staging of newly diagnosed prostate cancer. The systematic sextant biopsy of the prostate can add a number of staging parameters that, once combined into a biopsy-based staging system, may become useful in theraputic planning. The systematic biopsy