Assessment of disease

♦ PSA measurement

—routine screening not recommended in UK

—measure in all patients with outflow symptoms

—PSA > 4 ng/ml: clinical suspicion, requires transrectal ultrasound and needle biopsy —PSA > 50 ng/ml: often distant metastases

♦ Pathological grading: Gleasons' score predicts behaviour

♦ Isotope bone scan, CT, MRI in selected patients

Table 22.5 TNM staging of prostate cancer

T0

No evidence of tumour

Tla

Tumour, incidental finding at TURP (<5% chippings)

Tlb

Tumour, incidental finding at TURP (>5% chippings)

Tlc

Impalpable tumour identified by raised PSA

T2a

Tumour involves half of a lobe or less

T2b

Tumour involves more than a half of a lobe but not both lobes

T2c

Tumour involves both lobes

T3a

Unilateral extracapsular extension

T3b

Bilateral extracapsular extension

Tumour involves seminal vesicles

T4 Tumour invades bladder neck, rectum, pelvic side-wall

T4 Tumour invades bladder neck, rectum, pelvic side-wall

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