MUDr. Dana Maňasková


Vyhledávání na medicinman.cz
 

Diagnostika nádorů prostaty

Cystoscopy

  • Shows the urinary tract from inside the bladder
  • Thin, flexible camera tube inserted down the urethra

Transrectal ultrasonography

  • Creates a picture of the prostate
  • Urologists use transrectal ultrasound during prostate biopsy
  • Can sometimes see a hypoechoic area
    • Tissues or structures that reflect relatively less of the ultrasound waves directed at them
  • Ultrasound has poor tissue resolution
    • Generally not used clinically [11]


Biopsy

  • For microscopic examination
  • Tissue samples from the prostate via the rectum
  • Biopsy gun
    • Inserts and removes special hollow-core needles
      • Usually three to six on each side of the prostate
      • In less than a second [11]
  • Routinely done on an outpatient basis
  • Rarely require hospitalization
  • Antibiotics should be used to prevent complications like
    • Fever,
    • Urinary tract infections
    • Sepsis [11]
  • 55% of men report discomfort during prostate biopsy [11]

Gleason score

  • The tissue samples are then examined under a microscope
    • Cancer cells present
    • Evaluate [11]
  • Some prostate cancers are insignificant since they grow slowly (low Gleason score)
  • Prostate cancers that will grow aggressively (high Gleason score)


Bone scans

  • Reveal osteoblastic appearance due to increased bone density in the areas of bone metastasis
    • Opposite to what is found in many other cancers that metastasize.

CT scans


Digital rectal examination (DRE)

  • May allow a doctor to detect prostate abnormalities

Piflufolastat F 18 (Pylarify)

phase 3 CONDOR trial (NCT03739684) shared during the 2023 ASCO GU Cancers Symposium showed

  • Piflufolastat F 18 (Pylarify) given before positron emission tomography (PET) scanning
    • Led to changes in intended management in 39.1% of patients with PSA level below 0.5 ng/mL.1,2
  • Reinforces the impact and potential role of piflufolastat F 18 in informing patient management decisions in real-world scenarios
  • Jean-Claude Provost, MD.
  • 74.1% (20/27) of patients had a change in management
    • Which led to an escalation of treatment from local salvage therapy to systemic therapy
    • Or a shift from observation to initiating treatment
  • In 18 of the 20 patients who had an intensification of treatment, piflufolastat F 18 identified lesions.
  • Piflufolastat F 18 is a prostate-specific membrane antigen (PSMA)-targeted radiopharmaceutical and is approved in the United States for imaging patients with prostate cancer at the time of initial staging and at disease recurrence.
  • psa-levels">www.urologytimes.com/view/analysis-underscores-value-of-piflufolastat-f-18-imaging-in-men-with-low-psa-levels


Markery

Metabolity stanovované v diagnostickém panelu H NMR spectroscopy

  • Sarcosine, cysteine, glutamate, asparagines, glycine, leucine, proline, threonine, histidine, n-acetyl-aspartic acid, inosine, inositol, adenosine, taurine, creatine, uric acid, glutathione, uracil, kynurenine, glycerol-s-phosphate, glycocholic acid, suberic acid, glutamic acid, xanthosine, 4-acetamidobutyric acid and thymine [1]
  • Methyl histidine and proline
    • In blood, serum, plasma as well as urine [1]
    • Can be used to determine breast cancer, lung cancer, colon cancer and prostate cancer [1]
    • Limited set gives a higher specificity and selectivity than the complete metabolome. [1]

Moč PLS-DA analysis

  • Only the integral segments of Methylhistidine and Proline
    • Sensitivity of 100% and a specificity of 100%
  • Changes in the different metabolites included in the panel
Literatura:
[1] Patent WO2011128256A1 - Metabolic markers for diagnosing of cancer - Patenty Google [Internet]. [citován 4. červen 2013]. Dostupné od: www.google.com/patents/WO2011128256A1?cl=en&hl=cs&dq=%2215454-75-8%22+OR+%225-oxoproline%22+OR+%22proline,+5-oxo-%22+OR+%225-Carboxy-2-pyrrolidinone%22+OR+%225-Oxo-2-pyrrolidincarbons%C3%A4ure%22+OR+%222-Pyrrolidone-5-carboxylic+acid+%22+OR+%225-OXO-2-PYRROLIDINECARBOXYLIC+ACID%22&source=uds


Magnetic resonance imaging (MRI)

  • In those who are at low risk
    • Might help people choose active surveillance
  • At intermediate risk
    • It may help with determining the stage of disease
  • At high risk
    • Might help find bone disease
  • 2011 MRI is used to identify targets for prostate biopsy
    • Fusion MRI with ultrasound (US) or MRI-guidance alone
  • Men who are candidates for active surveillance
    • Fusion MR/US guided prostate biopsy detected 33% of cancers
    • Compared to 7% with standard ultrasound guided biopsy [11]: !!!
  • For surgical planning for men undergoing robotic prostatectomy
  • Help surgeons
    • Decide whether to resect or spare the neurovascular bundle
    • Determine return to urinary continence
    • Assess surgical difficulty [11]
  • PI-RADS Reporting system = Prostate Imaging-Reporting and Data System
    • Defining standards of high-quality clinical service for multi-parametric Magnetic Resonance Imaging (mpMRI), including image creation and reporting [11]

Endorectal coil magnetic resonance imaging

  • Closely evaluate the prostatic capsule and the seminal vesicles

PET scans


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Poslední aktualizace: 10. 12. 2023 21:59:57