Prostat Kanserinde Tanı ve Evreleme
Özet
Prostat kanseri genellikle erken evrede asemptomatiktir ve parmakla rektal muayene (PRM) ile serum prostat spesifik antijen (PSA) yüksekliği tanısal şüphe uyandırır. Kesin tanı histopatolojik incelemeyle konurken, biyopsi öncesinde kanser riskini belirlemek için PSA türevleri, çeşitli kan/idrar biyomarkerları ve özellikle klinik anlamlı tümörlerin saptanmasında yüksek duyarlılığa sahip multiparametrik manyetik rezonans görüntüleme (mpMRG) kullanılır. Standart transrektal ultrasonun tanısal değeri düşük olup biyopsiler transrektal veya transperineal yolla gerçekleştirilir. Hastalığın evrelemesi, optimal tedavinin seçimi ve risk gruplarının belirlenmesi amacıyla AJCC TNM sınıflandırması ve D'Amico risk kriterleri doğrultusunda yapılır. Lokal evrelemede en kullanışlı yöntem MRG iken, bölgesel lenf nodu (N) ve uzak metastaz (M) evrelemesinde bilgisayarlı tomografiye ve kemik taramasına kıyasla daha yüksek duyarlılık sunan Ga68-PSMA PET/BT, kolin PET/BT ve tüm vücut MRG gibi ileri görüntüleme yöntemleri tercih edilir. Avrupa Üroloji Derneği (EAU) kılavuzları, düşük riskli hastalar için ek tarama önermezken yüksek riskli durumlarda kapsamlı evreleme yapılmasını güçlü şekilde tavsiye eder.
Prostate cancer is generally asymptomatic in its early stages, and diagnostic suspicion is raised by digital rectal examination (DRE) abnormalities and elevated serum prostate-specific antigen (PSA) levels. While the definitive diagnosis is established through histopathological examination, PSA derivatives, various blood/urine biomarkers, and multiparametric magnetic resonance imaging (mpMRI)—which offers high sensitivity in detecting clinically significant tumors—are utilized before a biopsy to predict malignancy risk. Standard transrectal ultrasound has low diagnostic accuracy, and biopsies are performed via transrectal or transperineal approaches. Staging is carried out in accordance with the AJCC TNM classification and D'Amico risk stratification to estimate prognosis and select optimal treatment paths. MRI is the most useful modality for local staging; however, for regional lymph node (N) and distant metastasis (M) staging, advanced imaging modalities such as Ga68-PSMA PET/CT, choline PET/CT, and whole-body MRI are preferred as they deliver higher accuracy compared to conventional computed tomography and bone scans. European Association of Urology (EAU) guidelines do not recommend additional staging for low-risk disease but strongly advocate for comprehensive metastatic screening in high-risk cases.
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