eMedicine Specialties > Urology > Cancer, Prostate

Prostate Cancer - Cryotherapy: Workup

Author: Matthew R Cooperberg, MD, MPH, Assistant Professor, Department of Urology, University of California at San Francisco School of Medicine
Coauthor(s): Peter Carroll, MD, FACS, Chair, Professor, Department of Urology, University of California at San Francisco; Katsuto Shinohara, MD, Associate Adjunct Professor, Department of Urology, University of California at San Francisco; Consulting Surgeon, Urology Section, Veterans Affairs Medical Center
Contributor Information and Disclosures

Updated: Apr 27, 2009

Workup

Laboratory Studies

  • Prostate-specific antigen: A preprocedure PSA test is important for assessing risk and establishing a baseline from which the PSA level can be tracked after treatment.
  • Urine culture
  • CBC count (with platelet count)
  • Coagulation tests (ie, prothrombin time, activated partial thromboplastin time)

Imaging Studies

  • Transrectal ultrasonography
    • Modern cryoablation is performed under TRUS guidance, and a preprocedure scan is required (1) to plan treatment, (2) to assist in clinical staging by identifying any hypoechoic or hypervascular lesions (as well as extracapsular extension or seminal vesical involvement), (3) to estimate the prostate volume, and (4) to identify any large transurethral resection defect.
    • In most cases, TRUS has already been performed to obtain the prostate biopsy specimen by which the disease was diagnosed (see Diagnostic Procedures).
  • Bone scintigraphy
    • Nuclear scintigraphy (bone scan) is the most sensitive and readily available test for detecting metastatic disease to the bones.
    • Scintigraphy is recommended as a staging test in patients who present with a PSA level that exceeds 10 ng/mL, a Gleason score of more than 7, or indications of bone pain.
  • Computed tomography of the abdomen and pelvis
    • The goal of cross-sectional imaging in the setting of prostate cancer is to reveal local extension or metastases to the lymph nodes. Unfortunately, the sensitivity of available imaging modalities remains low.
    • CT scans reveal only 25-45% of lymph node metastases and 55-75% of cases of bulky local extension. CT scanning is therefore recommended only in patients at high risk of advanced disease, eg, those with a PSA level of more than 20 ng/mL, a Gleason score of 8-10, or clinical stage T3-T4 disease.24
  • Magnetic resonance imaging of the abdomen and pelvis
    • The sensitivity of MRI for lymph node metastasis detection is not superior to that of CT scanning.21
    • The use of endorectal coils and adjunctive magnetic resonance spectroscopy may eventually improve the utility of this test for local staging, but it is currently not recommended for routine clinical practice.

Diagnostic Procedures

  • Transrectal ultrasonography–guided prostate biopsy
    • TRUS-guided biopsy is the current criterion standard for diagnosis and grading of prostate cancer. The typical sextant procedure obtains biopsy cores from the apex, mid gland, and base on each side.
    • The yield of TRUS-guided biopsy is increased by obtaining extended-pattern biopsy specimens that also specifically sample the lateral zones, for a total of 10-14 cores or more.25 Furthermore, it is increasingly clear that the percentage of positive biopsy specimens has as much or greater prognostic significance than the canonical risk features of PSA level, Gleason score, and clinical T stage.26,27,28

Histologic Findings

The vast majority of prostate cancers are adenocarcinomas of the prostate, and these are graded with the Gleason grading system, which assesses the pattern of glandular organization and differentiation.29 Each tumor is assigned 2 numbers, 1 through 5, increasing with progressive dedifferentiation. The first number is the predominant pattern, and the second is the less-frequent pattern. The 2 numbers are added to produce a total Gleason score of 2-10.

More on Prostate Cancer - Cryotherapy

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Workup: Prostate Cancer - Cryotherapy
Treatment: Prostate Cancer - Cryotherapy
Follow-up: Prostate Cancer - Cryotherapy
Multimedia: Prostate Cancer - Cryotherapy
References
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References

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Further Reading

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Keywords

cryotherapy, prostate cancer, cryoablation, cryosurgery, cryoprobes, urethral warming catheters, brachytherapy, radiotherapy, radiation therapy, radical prostatectomy, systemic androgen deprivation therapy, transrectal ultrasound, TRUS, transurethral resection of the prostate, TURP, transurethral cryoablation, pelvic lymphadenectomy, neoadjuvant androgen ablation, prostate-specific antigen, PSA, benign prostatic hyperplasia, BPH, erectile dysfunction, ED, impotence, potency, incontinence, continence, penile numbness, rectourethral fistula, urethral stricture, hydronephrosis, small bowel obstruction

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Contributor Information and Disclosures

Author

Matthew R Cooperberg, MD, MPH, Assistant Professor, Department of Urology, University of California at San Francisco School of Medicine
Matthew R Cooperberg, MD, MPH is a member of the following medical societies: American Medical Association and California Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Peter Carroll, MD, FACS, Chair, Professor, Department of Urology, University of California at San Francisco
Disclosure: Nothing to disclose.

Katsuto Shinohara, MD, Associate Adjunct Professor, Department of Urology, University of California at San Francisco; Consulting Surgeon, Urology Section, Veterans Affairs Medical Center
Katsuto Shinohara, MD is a member of the following medical societies: American Institute of Ultrasound in Medicine and American Urological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Martin I Resnick, MD †, Former Lester Persky Professor and Chair, Department of Urology, Former Professor, Department of Oncology, Case Western Reserve University School of Medicine
Martin I Resnick, MD † is a member of the following medical societies: American College of Surgeons, American Federation for Medical Research, American Institute of Ultrasound in Medicine, American Medical Association, American Society for Bone and Mineral Research, American Society for Reproductive Medicine, American Society of Andrology, American Surgical Association, American Urological Association, Association for Academic Surgery, Endocrine Society, National Kidney Foundation, Ohio Urological Society, and Pan American Medical Association
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Gyrus-ACMI Honoraria Speaking and teaching

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
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