From the Guidelines
The diagnostic and treatment approach for suspected prostate cancer presenting as lobular masses begins with a thorough clinical evaluation including digital rectal examination (DRE) and prostate-specific antigen (PSA) testing, as recommended by the American College of Radiology Appropriateness Criteria 1.
Diagnostic Approach
The initial step in evaluating suspected prostate cancer is to perform a digital rectal examination (DRE) and measure the prostate-specific antigen (PSA) level. If abnormalities are detected, multiparametric MRI of the prostate should be performed to visualize and characterize suspicious lesions, followed by targeted biopsies of these areas along with systematic biopsies 1.
- Key diagnostic tools include:
- Digital rectal examination (DRE)
- Prostate-specific antigen (PSA) testing
- Multiparametric MRI of the prostate
- Targeted and systematic biopsies
Treatment Approach
Diagnosis is confirmed through histopathological examination of biopsy specimens, with Gleason scoring to determine cancer aggressiveness. Treatment options depend on disease stage, patient age, and comorbidities.
- For localized disease, options include:
- Active surveillance for low-risk cancer
- Radical prostatectomy
- External beam radiation therapy (typically 76-80 Gy over 7-9 weeks)
- Brachytherapy
- Advanced disease may require androgen deprivation therapy with medications like leuprolide (7.5 mg monthly), goserelin (10.8 mg every 3 months), or bicalutamide (50 mg daily) 1.
- Metastatic disease might necessitate chemotherapy with docetaxel (75 mg/m² every 3 weeks) or newer hormonal agents like abiraterone (1000 mg daily with prednisone 5 mg twice daily) or enzalutamide (160 mg daily).
Post-Treatment Follow-Up
After treatment, patients are followed at periodic intervals with measurement of serum prostate-specific antigen (PSA) levels to monitor for biochemical recurrence (BCR) 1.
- A first serum total PSA assay is recommended during the first 3 to 12 months after radical prostatectomy (RP) or radiation therapy (RT).
- When PSA is detectable following RP, a PSA assay should be repeated 1 to 3 months later to confirm this elevation and to estimate the PSA doubling time (PSADT). This approach is effective because prostate cancer often presents as nodular or lobular masses that can be detected through systematic evaluation, and treatment efficacy is enhanced by accurate staging and risk stratification 1.
From the Research
Diagnostic Approach for Suspected Prostate Cancer Presenting as Lobular Masses
- The diagnostic approach for suspected prostate cancer presenting as lobular masses involves a combination of digital rectal examination (DRE), prostate-specific antigen (PSA) testing, and imaging studies such as transrectal ultrasonography (TRUS) and magnetic resonance imaging (MRI) 2, 3, 4, 5, 6.
- DRE is a useful tool for detecting prostate cancer, especially in men with abnormal PSA levels or suspicious symptoms 2, 4.
- However, the diagnostic value of DRE as a standalone test is limited, and its use as a screening tool is being questioned in the era of MRI 3, 5.
- PSA testing is a more effective screening tool for prostate cancer, and its combination with DRE provides a more complete evaluation of the prostate gland for malignant involvement 2, 3.
- MRI is a valuable tool for detecting and characterizing prostate cancer, especially in men with elevated PSA levels or abnormal DRE findings 4, 5, 6.
Treatment Approach for Prostate Cancer Presenting as Lobular Masses
- The treatment approach for prostate cancer presenting as lobular masses depends on the stage and grade of the cancer, as well as the patient's overall health and preferences 2, 4, 6.
- Early detection and treatment of prostate cancer are critical for improving outcomes, and a combination of DRE, PSA testing, and imaging studies can help identify men who require further evaluation and treatment 2, 3, 4, 5, 6.
- Treatment options for prostate cancer may include surgery, radiation therapy, hormone therapy, or active surveillance, depending on the individual case 4, 6.
- The use of advanced imaging techniques such as 68Ga-prostate-specific membrane antigen (PSMA) PET and multiparametric MRI can help improve the diagnosis and characterization of prostate cancer, and guide treatment decisions 6.