Genitourinary Radiology > Male Pelvis > Prostate & Seminal Vesicles > Prostate Cancer

Prostate Cancer


Prostate cancer is more common that any other cancer in American men except for non-melanoma skin cancer. It may produce symptoms of urinary urgency, nocturia, frequency, and hesitancy--all of which are more likely to be caused by benign prostatic hypertrophy. However, if an asymmetric areas of induration or nodules are found on digital rectal examination, then prostate cancer is suspected and the prostate-specific antigen level should be evaluated. Trans-rectal biopsy is the gold standard for diagnosis.

Spread may occur by direct extension into the seminal vesicles, bladder base, and perivesical fat. Extracapsular spread is evaluated with transrectal prostate ultrasonography with biopsy or endorectal coil MR imaging +/- MR Spectroscopy.

Nodal metastases may be evaluated with CT or MRI, and biopsy is performed if nodes are greater than 10mm. If nodal disease is present, 80% have bone mets within 5 years. The obturator and internal/external iliac nodal chains are most commonly involved.

Bone metastases are evaluated by checking the PSA level, then performing a bone scan. Prostate specific imaging of distant disease can also be evaluated with nuclear medicine "prostascint" scan.

Staging System:

    T1: microscopic tumor, not palpable
    T2: macroscopic tumor, palpable (80% 5-year disease-free survival)
    T3: extracapsular extension (30% 5-year disease-free survival)
    T4: metastatic disease

CT scan of pelvis in patient with known prostate cancer. This innocuous appearing, small prostate gland (arrows) was positive for prostate cancer. The CT scan is crucial in staging the patient, looking for local adenopathy, local invasion and bone mets on bone windows (there was none).

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