[Prostate cancer: Diagnosis and staging].

Area of Science:

• Urology
• Oncology
• Diagnostic Medicine

Background:

• Serum prostate specific antigen (PSA) significantly improved prostate cancer diagnosis over 20 years.
• Pre-PSA era diagnosis relied on digital rectal examination (DRE), often detecting advanced, incurable cancers.
• Early diagnosis is now achievable, allowing for curable treatment of prostate cancer.

Purpose of the Study:

• To review the impact of PSA in prostate cancer diagnosis and screening.
• To highlight the role of transrectal ultrasound (TRUS) biopsies in diagnosis.
• To discuss the limitations of current imaging techniques in assessing cancer extent.

Main Methods:

• Review of publications on prostate cancer screening and diagnostic tools.
• Analysis of the accuracy of PSA, DRE, and TRUS in diagnosis.
• Evaluation of imaging techniques for assessing loco-regional cancer extension.

Main Results:

• PSA assessment enables earlier prostate cancer detection compared to DRE alone.
• Transrectal ultrasound (TRUS) prostatic biopsies are essential for confirming diagnosis due to PSA's low specificity.
• Current imaging techniques struggle to visualize primary tumors or microscopic metastases for accurate staging.

Conclusions:

• PSA has transformed prostate cancer diagnosis, facilitating early, curable-stage detection.
• Despite PSA's utility, biopsies are indispensable for accurate diagnosis.
• Combining clinical data (DRE, PSA, biopsy) improves pathological staging and guides therapeutic strategies for heterogeneous prostate cancers.