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Volume 11, Issue 1 (January 2009) 11, 74–80; 10.1038/aja.2008.19

Prostate cancer: diagnosis and staging

Nigel Borley and Mark R. Feneley

Department of Urology, University College Hospitals, London NW1 2BU, UK

Correspondence: Dr Nigel Borley, Dr Nigel Borley, University College Hospitals, 235 Euston Road, London NW1 2BU, UK. Fax: +44-20-7380-9303 E-mail: nigel.borley@uclh.nhs.uk

Received 29 September 2008; Accepted 2 October 2008; Published online 1 December 2008


Prostate cancer represents an increasing health burden. The past 20 years, with the introduction of prostate-specific antigen (PSA), has seen prostate cancer move increasingly from a condition that presented with locally advanced disease or metastases to one that is found upon screening. More is also known about the pathology of pre-malignant lesions. Diagnosis relies on trans-rectal ultrasound (TRUS) to obtain biopsies from throughout the prostate, but TRUS is not useful for staging. Imaging for staging, such as magnetic resonance imaging or computed tomography, still has a low accuracy compared with pathological specimens. Current techniques are also inaccurate in identifying lymph node and bony metastases. Nomograms have been developed from the PSA, Gleason score and clinical grading to help quantify the risk of extra-capsular extension in radical prostatectomy specimens. Improved clinical staging modalities are required for more reliable prediction of pathological stage and for monitoring of response to treatments.

Keywords: diagnosis, imaging, prostate cancer, PSA, staging

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