Fast Five Quiz: Prostate Cancer Diagnosis and Staging

Chad R. Tracy, MD


June 15, 2021

Figure 1. Light micrograph of prostate cancer showing intraluminal eosinophilic crystalloids within the malignant glands.

The cutoff for prostate cancer starts with Gleason score of 3+3=6. Scoring is a sum of the two most common patterns and accounts for the heterogeneity among patients with prostate cancer.

A biopsy can help differentiate between a cyst or calculus from cancer foci, but cysts and stones cannot be accurately differentiated from cancer based on DRE findings alone; therefore, abnormal DRE results should prompt a high index of suspicion. The sensitivity of DRE has been estimated to be 0.51, with a specificity of 0.59 and a positive predictive value of 0.41. Serial DREs over time are recommended.

Multiple factors play into normal PSA levels, including age and prostate size. The European Randomized Study of Screening for Prostate Cancer suggests a PSA cutoff value of 3 ng/mL or higher as an indication for lateralized sextant biopsy. For men with an initial PSA value of less than 3 ng/mL, the risk of developing aggressive prostate cancer and death has been found to significantly increase with PSA values in the 2-2.9 ng/mL range, although the overall risk of aggressive prostate cancer–related death is still not significant in this window.

Shao and colleagues suggested that if clinicians are unable to distinguish indolent from aggressive cancers, lowering the biopsy threshold might increase the risk of overdiagnosis and overtreatment, an ongoing concern in the setting of prostate cancer.

Learn more about prostate cancer diagnosis and staging.


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