Transrectal ultrasonography-guided needle biopsy of the prostate is indicated for tissue diagnosis in patients who present with elevated PSA levels or abnormal digital rectal examination findings. This study should be repeated, if indicated, to determine local recurrence.
In cases of suspected advanced prostate cancer, the hematologic workup should include a complete blood cell count; liver function tests; and a chemistry profile, including levels of serum creatinine, acid and alkaline phosphatase, and serum PSA, as well as a free-to-total PSA ratio. Any demonstration of abnormalities by these tests may warrant additional studies. Note that not all patients with relatively high-grade prostate cancer have elevated PSA levels, nor do elevated PSA levels always signify disease progression.
At initial presentation with prostate cancer, the value of a bone scan is limited in patients with a Gleason score less than 7 and a PSA level < 20 ng/mL. Those with a Gleason score greater than 6 may be candidates for a bone scan, irrespective of their PSA level. A bone scan may be performed as a baseline for treatment response in patients with recurrent metastatic disease at high risk of having bony metastatic disease. Activity in the bone scan may not be observed until 5 years after micrometastasis has occurred; therefore, a negative bone scan does not rule out metastasis. In biochemical failure, a follow-up bone scan usually has no value until the PSA level exceeds 30 ng/mL.
For more on the workup of metastatic and advanced prostate cancer, read here.
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Cite this: Bradley Schwartz. Fast Five Quiz: Test Your Knowledge of Advanced Prostate Cancer - Medscape - Nov 16, 2017.