Initial staging and evaluation of men with newly diagnosed prostate cancer
- Philip W Kantoff, MD
Philip W Kantoff, MD
- Section Editor — Testicular Cancer
- Chairman of Medicine
- Memorial Sloan Kettering Cancer Center
- Mary-Ellen Taplin, MD
Mary-Ellen Taplin, MD
- Associate Professor of Medicine
- Harvard Medical School
- Joseph A Smith, MD
Joseph A Smith, MD
- Professor and Chairman of Urologic Surgery
- Vanderbilt University School of Medicine
- Section Editors
- Nicholas Vogelzang, MD
Nicholas Vogelzang, MD
- Section Editor — Prostate Cancer
- Professor of Medicine
- University of Nevada School of Medicine
- US Oncology Research
- W Robert Lee, MD, MS, MEd
W Robert Lee, MD, MS, MEd
- Section Editor — Prostate Cancer
- Professor of Radiation Oncology
- Duke University Medical Center
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
Prostate cancer is the second most common cancer in men worldwide, with an estimated 1,100,000 cases and 307,000 deaths in 2012 . In the United States there will be an estimated 161,000 cases and 26,700 deaths in 2017 . The clinical behavior of prostate cancer ranges from a microscopic, well-differentiated tumor that may never be clinically significant to an aggressive, invasive cancer that ultimately results in metastases, morbidity, and death.
Once the diagnosis of prostate cancer is established, further evaluation that incorporates known risk factors is required to determine appropriate treatment options. The prostate cancer staging system and the initial staging evaluation are reviewed here.
The initial clinical presentation including indications for biopsy, the ramifications of risk stratification, and the approach to treatment are discussed separately.
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- STAGING SYSTEM
- Clinical versus pathologic staging
- Tumor (T)
- - Clinical T stage
- - Pathologic T stage
- Node (N)
- Metastasis (M)
- Serum PSA
- Histologic grade group
- Prognostic stage groups
- STAGING EVALUATION
- General approach
- Evaluating extent of local disease
- Evaluation of regional lymph nodes
- Evaluation for distant metastases
- - Technetium-99 bone scan
- - Other imaging modalities
- Axial skeleton MRI
- Circulating prostate cancer cells
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS