bahan refrat ca prostat

8/12/2019 Bahan Refrat CA Prostat

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http://www.cancer.org/acs/groups/cid/documents/webcontent/003134-pdf.pdf

http://repository.usu.ac.id/bitstream/1234567!/3112/4/"hapter#20$$.pdf

ocw.usu.ac.id/...ANATOMI/pato%ogi&anatomi&s%ide&'an'er&prostat.pdf

http://www.ncbi.n%m.nih.go(/pmc/artic%es/)*"271163/pdf/'+r-1-110.pdf

http://pubs.rsna.org/doi/pdf/10.114/radio%.243103050

http://www.uroweb.org/g%s/pdf/0#20)rostate#20"ancer&,#20*arch#2013th#202012.pdf

Survival rates for prostate cancer

ur(i(a% rates are often used by doctors as a standard way of discussing a persons prognosis

out%oo'. ome patients with cancer may want to 'now the sur(i(a% statistics for peop%e in

simi%ar situations whi%e others may not find the numbers he%pfu% or may e(en not want to 'now

them. $f you wou%d rather not read the sur(i(a% rates s'ip to thenet section.

he 5-year sur(i(a% rate refers to the percentage of patients who %i(e at least 5 yearsafter their

cancer is diagnosed. f course many of these peop%e %i(e much %onger than 5 years and many

are cured.

i(e-year relativesur(i(a% rates such as the numbers be%ow assume that some peop%e wi%% die ofother causes and compare the obser(ed sur(i(a% with that epected for peop%e without the cancer.

his is a better way to see the impact of the cancer on sur(i(a%.

$n order to get 5-year sur(i(a% rates doctors ha(e to %oo' at peop%e who were treated at %east 5

years ago. $mpro(ements in detection and treatment since then may resu%t in a more fa(orab%e

out%oo' for peop%e now being diagnosed with prostate cancer.

ur(i(a% rates are often based on pre(ious outcomes of %arge numbers of peop%e who had the

disease but they cannot predict what wi%% happen in any particu%ar persons case. *any other

factors may affect a persons out%oo' such as the patient8s age and hea%th the treatment recei(ed

and how we%% the cancer responds to treatment. 9our doctor can te%% you how the numbers be%ow

may app%y to you as he or she is fami%iar with the aspects of your particu%ar situation.

ccording to the most recent data when inc%uding allstages of prostate cancer:

he re%ati(e 5-year sur(i(a% rate is a%most 100#

he re%ati(e 10-year sur(i(a% rate is !!#

he 15-year re%ati(e sur(i(a% rate is !4#

;eep in mind that +ust as 5-year sur(i(a% rates are based on patients diagnosed and first treated

more than 5 years ago10-year sur(i(a% rates are based on patients diagnosed more than 10 years

ago and 15-year sur(i(a% rates are based on patients diagnosed at %east 15years ago.

Survival rates by stage

he


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Regional stagemeans the cancer has spread from the prostate to nearby areas. his

inc%udes stage $$$ cancers and the stage $> cancers that ha(ent spread to distant parts of the

body such as 4 tumors and cancers that ha(e spread to nearby %ymph nodes cancers ? a%% cancers that ha(e spread to

distant %ymph nodes bones or other organs *1.

5year relative survival by stage at t!e time of diagnosis

Stage 5year relative

survival rate

%oca% near%y 100#

regiona% near%y 100#

distant 2#

http://www.cancer.org/cancer/prostatecancer/detai%edguide/prostate-cancer-sur(i(a%-rates

Radiograp!y)%ain radiographs of the pe%(is cannot be used to demonstrate %oca%i@ed disease in the prostate

and they are genera%%y on%y needed in the e(a%uation of metastatic disease. *ost s'e%eta%

metastases from prostate cancer about 5# are osteob%astic and are (isib%e as an area of

abnorma% tracer acti(ity on a radionuc%ide bone scan. $n case of doubt targeted imaging with

s'e%eta% radiographs can he%p distinguish metastatic areas from degenerati(e disease. he image

be%ow depicts prostate cancer metastases on radiography.

)e%(ic radiograph shows widespread osteob%astic sc%erotic

metastases from prostate cancer.

chest radiograph may be used in the e(a%uation of a patient with 'nown prostate cancer to

assess chest symptoms weight %oss %oca%i@ed bone pain or constitutiona% symptoms.

"omputed omography

" scanning has %itt%e (a%ue in demonstrating intraprostatic patho%ogy and in %oca% staging.

Aowe(er it may be he%pfu% in detecting metastatic disease such as %ymph node in(o%(ement or

bone metastases.


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metastases.C!D Aowe(er noda% staging re%ies on assessment of %ymph node si@e and neither "

scan nor *$ can demonstrate cancer within %ymph nodes that are not en%arged.

$n case of doubtfu% radionuc%ide tracer acti(ity targeted imaging with " scanning can be

he%pfu% in diagnosing osteob%astic and osteo%ytic s'e%eta% metastases.

" scanning may a%so be used to depict soft-tissue metastases e%sewhere in the body. he "

scans be%ow depict metastatic prostate cancer.

ia% computed tomography " scan at the %e(e% of the 'idneys

shows etensi(e para-aortic %ymphadenopathy arrows which resu%ts from ad(anced prostate

cancer *etastatic prostate cancer arrows in(o%(es the soft tissues

at the right side of the s'u%% base. he patient presented with right-sided crania% ner(e?E$$ pa%sy.

*agnetic esonance $maging

tate-of-the-art *$ consists of morpho%ogic 1- and 2-weighted imaging comp%emented

with one or more functiona% techniFues diffusion-weighted imaging dynamic contrast-enhanced

*$ and/or spectroscopy. he techniFue is therefore ca%%ed mu%tiparametric *$ mp*$.C10D

)otentia% ro%es of *$ are in guiding prostate biopsy %oca% staging of biopsy-pro(en cancers

treatment p%anning and posttreatment sur(ei%%ance.C11D

Morp!ologic MRI "T# and T$%eig!ted imaging&

n 1-weighted images the prostate appears homogeneous with medium signa% intensityG

neither the @ona% anatomy nor intraprostatic patho%ogy is disp%ayed but if the *$ is performed

after biopsy postbiopsy hemorrhage can be identified as areas of high 1-signa% intensity.

2-weighted seFuences eFuisite%y depict the prostatic @ona% anatomy. he centra% g%and usua%%y

consists of nodu%ar areas of (arying signa% intensity depending on the re%ati(e amount of
http://refimgshow%2815%29/http://refimgshow%2814%29/


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hypointense stroma% and hyperintense g%andu%ar e%ements.C3 4D he norma% periphera% @one has

high signa% intensity as it is main%y composed of numerous ducta% and acinar e%ements with

hyperintense secretions.C3D

*ost prostate cancers can be (isua%i@ed as %ow-signa%-intensity areas within the high-signa%-

intensity norma% tissue bac'ground of the periphera% @one. Hecause about 70# of a%% prostate

cancers occur within the periphera% @oneC12Dmorpho%ogic 2-weighed imaging can thus depict the

ma+ority of a%% prostate cancers. n the other hand %ow-signa%-intensity tumors in the centra%

g%and are usua%%y indistinguishab%e from far more common hypointense stroma% hyperp%asia.C13

14D herefore centra% g%and tumors are more difficu%t to detect than periphera% @one cancers.

2-weighted imaging can be performed on a 1.5-es%a unit preferab%y with use of an endorecta%

coi% or on a 3-es%a unit. eported sensiti(ities 22-5# and specificities 50-!!# (ary

wide%yC15D the %atter i%%ustrating the fact that %ow-signa%-intensity areas are by no means specific

for prostate cancer since benign conditions such as prostatitis hemorrhage hyperp%astic

nodu%es or posttreatment hormona% or irradiation changes may eFua%%y show %ow signa%

intensity as shown in the images be%ow.

"orona% 2-weighted magnetic resonance imaging *$ study ofthe prostate g%and obtained by using an eterna% coi%. ,ow signa% intensity arrow is seen on the

%eft side of the prostate at the site of a biopsy-pro(en prostate cancer.

Indorecta% aia% 2-weighted magnetic resonance imaging *$ scan in a patient with a

prostate-specific antigen %e(e% of ng/m, and right-sided prostate cancer. ,ow signa% intensity is

demonstrated in the right periphera% @one arrow.
http://refimgshow%289%29/http://refimgshow%287%29/


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n important ro%e of morpho%ogic 2-weighted *$ is the assessment of %oca% etracapsu%ar

etension and in(asion of the semina% (esic%e in a patient with no documented distant metastases.

igns of etracapsu%ar spread inc%ude 1 irregu%ar bu%ging of the prostatic out%ine see the image

be%ow 2 breach of the capsu%e with infi%tration of the periprostatic fat 3 asymmetry of the

neuro(ascu%ar bund%es and 4 %oss of the rectoprostatic ang%e.C16 17D emina% (esic%e in(asion may

be suspected in the presence of an abnorma%%y %ow signa% intensity within the %umen of the

semina% (esic%e or by foca% thic'ening of the semina% (esic%e wa%%s.C1D

)atient with biopsy-pro(en prostate cancer. ia% 1-weighted

magnetic resonance imaging *$ scan of the pe%(is shows an en%arged %eft obturator node

arrow.

he reported sensiti(ities and specificities for %oca% staging range from 14-100# and from 67-

100# respecti(e%y.C15D Hecause *$ cannot detect microscopic in(asion %ow sensiti(ity (a%ues

are not unepected. he main indication for %oca% *$ staging howe(er is the assessment of

capsu%ar and (esicu%ar integrity in a patient c%inica%%y staged as 1c or 2c. uch patients

ob(ious%y shou%d not be inappropriate%y upstaged by *$ and therefore a conser(ati(e approach

is adopted in which on%y uneFui(oca% capsu%ar or (esicu%ar etensions are assigned a 3 status.his imp%ies high specificity reading no fa%se positi(es at the epense of a %ower sensiti(ity.

'unctional MRI

o increase both the sensiti(ity and specificity of *$ in the detection of prostate cancer se(era%

functiona% techniFues can be added. hese ta'e ad(antage of (arious tumor phenotypes such as

ce%%u%ar density diffusion-weighted imaging angiogenesis dynamic contrast-enhanced *$

and tumor metabo%ism magnetic resonance spectroscopy.

Diffusion-weighted imaging

Jiffusion-weighted imaging pro(ides information about the amount of random Hrownian

mo(ements of water mo%ecu%es. )rotons are (ery mobi%e in norma% water-rich g%andu%ar tissue

but restricted in their mo(ement in dense%y pac'ed water-poor tissue such as tumor areas which

contain many hydrophobic ce%% membranes. s a conseFuence prostate cancer in both the

periphera% @one and transition @one disp%ays significant%y %ower diffusion compared with benign

prostatic tissue.C1!D

Jiffusion-weighted imaging in the prostate is a fast and easy techniFue that has rapid%y gained

popu%arity. %though it produces poor spatia% reso%ution compared with 2-weighted images it is

usefu% as a supp%ementary techniFue in drawing attention to areas of suspicion at 1.5 es%a and 3
http://refimgshow%2810%29/


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es%a hence increasing the accuracy of morpho%ogic 2-weighted imaging. urthermore an

interesting corre%ation seems to eist between the degree of diffusion restriction and tumor

aggressi(eness B%eason score.C20D

Dynamic contrast-enhanced imaging

fter an intra(enous bo%us in+ection of 0.1 mmo%/'g of a gado%inium contrast agent the prostate

is seria%%y imaged with a 1-weighted seFuence e(ery 2-5 seconds. C21D *ost prostate carcinomas

show ear%ier and more pronounced contrast enhancement a%though some o(er%ap sti%% is apparent

in the enhancement patterns between tumors and benign conditions such as prostatitis

postbiopsy hemorrhage and benign prostatic hyperp%asia. ccuracies of 70-!0# ha(e been

reported for dynamic contrast-enhanced *$ in the primary diagnosis of prostate carcinoma in

the periphera% @one.C21 22D he ro%e of contrast-enhanced *$ is primari%y to impro(e specificity

because 2-weighted *$ is more sensiti(e.C11Dee the image be%ow.

Jynamic contrast-enhanced magnetic resonance imaging *$

scan in a patient with an etensi(e%y enhancing prostate carcinoma in the right prostate ha%(e.

Magnetic resonance spectroscopy

*agnetic resonance spectroscopy pro(ides information about the re%ati(e concentration of

ce%%u%ar metabo%ites in the prostate such as citrate and cho%ine. "itrate is a mar'er of norma%

prostatic tissue whi%e an increased concentration of cho%ine is suggesti(e of a tumor %esion.C23D he comp%ementary changes of both metabo%ites are used to predict the presence or absence of

prostate cancer.

Khen used in combination with 2-weighted images sensiti(ities and specificities ranging from

5!-!4# and 0-!5# respecti(e%y ha(e been reported.C24D usefu% corre%ation between the

cho%ine-to-citrate ratio and tumor aggressi(eness B%eason score has a%so been demonstratedC25D and a particu%ar%y high negati(e predicti(e (a%ue was found in ru%ing out high-grade prostate

cancer ie B%eason 4L3 or higher grade in men presenting with an increased prostate-specific

antigen ) (a%ue.C26D

$n a 2013 systematic re(iew magnetic resonance spectroscopy had the highest sensiti(ity !2#of the *$ techniFues as we%% as a higher specificity than 2-weighted *$.C27D

ee the image be%ow.
http://refimgshow%2820%29/


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)roton magnetic resonance spectrum in a norma% (oe% %eft

image: high citrate pea' and %ow cho%ine pea' and a cancer (oe% right image: %ow citrate andhigh cho%ine pea'.

Nodal staging


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$sotopic bone scans show mu%tip%e areas of increased tracer acti(ity from

metastatic prostate cancer. $sotopic bone scans. Jiffuse metastases

demonstrate a superscan appearance.


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ia% transrecta% u%trasonographic scan shows etensi(e

hypoechoic area arrows in the right periphera% @one. Hiopsy re(ea%ed prostatic adenocarcinoma.

TR(S in diagnosis

)rostate cancers can be (isua%i@ed as hypoechoic nodu%es within the isoechoic norma% periphera%

@one but they may be isoechoic hyperechoic or mu%tifoca% as we%% so N has ma+or

%imitations in fu%%y demonstrating prostate cancers. urthermore N has a %ow specificity

because many nonma%ignant conditions eg prostatitis prostatic atrophy infarctiongranu%omatous prostatitis may appear as simi%ar%y hypoechoic areas in the periphera% @one of the

prostate. or this reason the sensiti(ity and specificity of N are far too %ow for sonographic

prostate cancer screening and the main ro%es of N are measuring the prostate (o%ume for

estimation of the prostate-specific antigen C)D density and pro(iding guidance for biopsy of

the prostate.C2!D

ee the images be%ow.

ia% transrecta% u%trasonographic scan shows a hypoechoic area

in %eft periphera% @one and a sma%% hypoechoic area in right periphera% @one arrows. Hiopsy

re(ea%ed an adenocarcinoma B%eason grade 6. ia% transrecta%

sonogram in a patient with norma% resu%ts during digita% recta% eamination and a prostate-

specific antigen ) %e(e% of ! ng/m,. $mage shows etensi(e bi%atera% but predominant%y

%eft-sided hypoechoic areas in the periphera% @one arrows. Hiopsy confirmed a B%eason grade
http://refimgshow%283%29/http://refimgshow%283%29/http://refimgshow%282%29/http://refimgshow%281%29/


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prostate cancer. *inor capsu%ar irregu%arity is present on the %eftG this is consistent with a 3

tumor.

nci%%ary sonographic too%s may impro(e to some etent the diagnostic performance of N.

"o%or or power Jopp%er u%trasonography may show increased (ascu%arity in a cancer area but a

wide range of diagnostic accuracies has been reported.C2!D


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N can demonstrate bu%ges of the prostate capsu%ar out%ine or o(ert etracapsu%ar etension.

)eriphera% @one tumors %onger than 2.3 cm that contact the fibromuscu%ar rim surrounding the

prostate may be associated with etracapsu%ar in(asion.


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prostate cancer screening and the main ro%es of N are measuring the prostate (o%ume for

estimation of the prostate-specific antigen C)D density and pro(iding guidance for biopsy of

the prostate.C2!D

ee the images be%ow.

ia% transrecta% u%trasonographic scan shows a hypoechoic area

in %eft periphera% @one and a sma%% hypoechoic area in right periphera% @one arrows. Hiopsy

re(ea%ed an adenocarcinoma B%eason grade 6. ia% transrecta%

sonogram in a patient with norma% resu%ts during digita% recta% eamination and a prostate-

specific antigen ) %e(e% of ! ng/m,. $mage shows etensi(e bi%atera% but predominant%y

%eft-sided hypoechoic areas in the periphera% @one arrows. Hiopsy confirmed a B%eason grade

prostate cancer. *inor capsu%ar irregu%arity is present on the %eftG this is consistent with a 3

tumor.nci%%ary sonographic too%s may impro(e to some etent the diagnostic performance of N.

"o%or or power Jopp%er u%trasonography may show increased (ascu%arity in a cancer area but a

wide range of diagnostic accuracies has been reported.C2!D


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$n e%astography prostate cancers appear as areas of decreased e%asticity increased stiffness and

both Fua%itati(e and Fuantitati(e methods ha(e been de(e%oped to assess the tissue e%asticity.

ensiti(ities and specificities range from 71-2# and 60-!5# respecti(e%y.C30D I%astography-

guided transrecta% biopsies ha(e a%so been shown to doub%e the cancer detection rate compared

with the standard systematic biopsy strategy.C31D ee the image be%ow.

ia% transrecta% u%trasonographic scan in a patient with c%inica%

benign prostatic hyperp%asia H)A and a serum prostate-specific antigen ) %e(e% of 11

ng/m,. In%argement of the transition @one is present but no foca% abnorma%ity is obser(ed in the

periphera% @one. ystematic 6-core biopsy re(ea%ed adenocarcinoma from both %obes of the

prostate ie this is an isoechoic tumor in the periphera% @one of both prostatic %obes.

nother in(estigationa% techniFue is Aistoscanning which integrates specific acoustic signatures

from different tissue types eg irregu%ar morpho%ogy increased (ascu%ari@ation modifications in

stiffness into a characteri@ation a%gorithm to detect and %oca%i@e prostate cancer and enab%e

transrecta% biopsy targeting.

TR(S in staging

N can demonstrate bu%ges of the prostate capsu%ar out%ine or o(ert etracapsu%ar etension.

)eriphera% @one tumors %onger than 2.3 cm that contact the fibromuscu%ar rim surrounding the

prostate may be associated with etracapsu%ar in(asion.

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