Diagnosis, Clinical Work Up, TNM Classification, Markers

Abstract

Prostate cancer (PCa) is the most common malignancy in developed countries, and the incidence is rapidly rising. Today, early detection is mostly induced by a large prescription of prostate-specific antigen (PSA) blood test. Although PSA remains the gold standard for diagnosis, clinical rectal examination is essential for staging prostate cancer and deciding treatment.

In this chapter, we give an overview on utilization of PSA to improve the sensibility and specificity of the test during early diagnosis. We also discuss the place of new molecular isoforms of PSA, novel blood, urine, and tissue markers useful for screening.

Finally, limits and performance of multimodal MRI as a diagnostic tool of PCa are reviewed as this imaging study is more and more useful, giving meaning to new prostate biopsy techniques and focal therapy protocols.

Appendices

Appendix A

	Not at all	Less than 1 time in 5	Less than half the time	About half the time	More than half the time	Almost always
1. Over the past month, how often have you had a sensation of not emptying your bladder completely after you finished urinating?	0	1	2	3	4	5
2. Over the past month, how often have you had to urinate again less than 2 h after you finished urinating?	0	1	2	3	4	5
3. Over the past month, how often have you found you stopped and started again several times when you urinated?	0	1	2	3	4	5
4. Over the past month, how often have you found it difficult to postpone urination?	0	1	2	3	4	5
5. Over the past month, how often have you had a weak urinary stream?	0	1	2	3	4	5
6. Over the past month, how often have you had to push or strain to begin urination?	None	1 time	2 times	3 times	4 times	5 times or more
7. Over the past month, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?	0	1	2	3	4	5

Total Symptom Score

The International Prostate Symptom Score uses the same seven questions as the AUA Symptom Index (presented above) with the addition of the following Disease Specific Quality of Life Question (bother score) scored on a scale from 0 to 6 points (delighted to terrible):

If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?

Individual Items of International Index of Erectile Function Questionnaire and Response Options (US Version)

Question/Response Options

• Q1:How often were you able to get an erection during sexual activity?

  • 0  =  No sexual activity

  • 1  =  Almost never/never

  • 2  =  A few times (much less than half the time)

  • 3  =  Sometimes (about half the time)

  • 4  =  Most times (much more than half the time)

  • 5  =  Almost always/always

• Q2:When you had erections with sexual stimulation, how often were your erections hard enough for penetration?

  • 0  =  No sexual activity

  • 1  =  Almost never/never

  • 2  =  A few times (much less than half the time)

  • 3  =  Sometimes (about half the time)

  • 4  =  Most times (much more than half the time)

  • 5  =  Almost always/always

• Q3:When you attempted sexual intercourse, how often were you able to penetrate (enter) your partner?

  • 0  =  Did not attempt intercourse

  • I  =  Almost never/never

  • 2  =  A few times (much less than half the time)

  • 3  =  Sometimes (about half the time)

  • 4  =  Most times (much more than half the time)

  • 5  =  Almost always/always

• Q4:During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?

  • 0  =  Did not attempt intercourse

  • I  =  Almost never/never

  • 2  =  A few times (much less than half the time)

  • 3  =  Sometimes (about half the time)

  • 4  =  Most times (much more than half the time)

  • 5  =  Almost always/always

• Q5:During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

  • 0  =  Did not attempt intercourse

  • 1  =  Extremely difficult

  • 2  =  Very difficult

  • 3  =  Difficult

  • 4  =  Slightly difficult

  • 5  =  Not difficult

• Q6How many times have you attempted sexual intercourse?

  • 0  =  No attempts

  • 1  =  One to two attempts

  • 2  =  Three to four attempts

  • 3  =  Five to six attempts

  • 4  =  Seven to ten attempts

  • 5  =  Eleven  +  attempts

• Q7:When you attempted sexual intercourse, how often was it satisfactory for you?

  • 0  =  Did not attempt intercourse

  • 1  =  Almost never/never

  • 2  =  A few times (much less than half the time)

  • 3  =  Sometimes (about half the time)

  • 4  =  Most times (much more than half the time)

  • 5  =  Almost always/always

(Raymond et al. 1997)

Appendix C

Category	Weights of the comorbid conditions
Myocardial infarct	1
Congestive heart failure	1
Peripherical vascular disease	1
Cerebrovascular disease	1
Dementia	1
Chronic pulmonary disease	1
Connective tissue disease	1
Ulcer disease	1
Mild liver disease	1
Diabetes	1
Hemiplegia	2
Moderate or severe renal disease	2
Diabetes  +  end organ damage	2
Any tumor	2
Leukemia	2
Lymphoma	2
Moderate or severe liver disease	3
Metastatic solid tumor	6
AIDS	6

The 19 conditions contributing to conventional Charlson score