MRT Prostata_Blase

Namenlos

Prostata_MRT_Guidlines_2016

multiparameter_Prostata_mrt_deutsch

prostatakarzinom

prostatakarzinom_Grading_mit_MRT_Diffusion

www.prostata_PSA

 

[gss ids=3872,3873,3874,3875,3876,3877,3878,3879,3880,3881,3882 columns=1 link=file carousel="fx=carousel" name=254]

 

Allerdings sind nur ca. 50% der Prostatakarzinome
tastbar und ca. 50% der tastbaren Knoten sind histologisch keine Prostatakarzinome. Der PSA-Wert kann einerseits den kritischen Grenzwert von 4,0 ng/ml auch bei benigner Prostatahyperplasie
(BPH) und akuter oder chronischer Prostatitis überschreiten. Andererseits haben aber bis zu 25% der Patienten mit PCA einen „normalen“ PSA-Wert .

Bei Beachtung der einschlägigen Kontraindikationen kann Butylscopolamid (Buscopan®) oder Glukagon zur Verringerung der Darmbewegung eingesetzt werden. Allerdings reicht es meistens, den Ballon der ERC im entleerten Rektum mit 80–100 ml Luft zu füllen.Die ERC ist richtig positioniert, wenn ihre konkave Vorderfläche der konvexen, dorsalen Fläche der Prostata glatt anliegt und die Spulenartefakte im Bild beidseits nahe am neurovaskulären Bündel
der Prostata liegen .Eine entsprechende Markierung am Stiel der ERC zeigt dann nach ventral.

Die MR-Spektroskopie der Prostata erkennt das PCA an dessen deutlich erhöhtem Cholinsignal, während das Zitratsignal normal oder verringert sein kann. Entscheidend
für die Diagnose ist das Verhältnis der Flächenintegrale unter den Kennlinien der verschiedenen
Stoffwechselprodukte im MR-Spektrum [9, 16, 8]. Für (Cholin+Kreatin)/Zitrat sind verschiedene
Grenzwerte veröffentlicht worden. Ein guter Anhaltswert für gesundes Prostatagewebe der peripheren
Zone in der MRS bei 1,5 T ist jedoch (Cholin+Kreatin)/Zitrat <0,5

 

Sequenzen:
T1FSE Prostata u. Becken axial/T2FSE Prostata in 3 Ebenen,

Diffusonssequenzen, dynamische KM Sequenzen.

MRT_Prostata_Blase

CA_BPH_Prostata_Review

Prostatacancer: Diagnosis and Staging

PSA Bestimmung und Prostate Health Index (phi):

Für den Prostate Health Index (phi) werden die drei Marker PSA, freies PSA und [-2]proPSA zu einem Ergebnis (phi) verrechnet.

Literaturübersicht zum Prostate Health Index phi

phi-Kliniker-Broschüre

phi-Laborliste Deutschland

Individualized Risk Assessment of Prostate Cancer:

http://deb.uthscsa.edu/URORiskCalc/Pages/uroriskcalc.jsp

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4 Responses to “MRT Prostata_Blase”

  1. Werner Says:

    FDA Warns of Prostate Cancer Risk With Reductase Inhibitors

    Roxanne Nelson
    http://www.medscape.com/viewarticle/744325

    Management of BPH and Prostate Cancer Reviewed
    http://www.medscape.com/viewarticle/733024

  2. Werner Says:

    GRADING:

    The standard approach for grading prostate cancer depends on a Gleason value, which is determined on the basis of the pathologic evaluation of a prostatectomy specimen and is commonly estimated from prostate biopsy tissue.[10] Prostate cancer patterns are assigned a number from 1 to 5 (well differentiated to very poorly differentiated); the Gleason value is created by adding the scores of the most common pattern grades present to those of the highest-grade patterns present.

  3. admin Says:

    Eine Entscheidungshilfe, ob eine Re-Biopsie tatsächlich notwendig ist, kann in dieser Situation der PCA3 („prostate cancer antigen 3“)-Test liefern. Dieser urinbasierte Biomarker wird in Prostatakarzinomzellen etwa 100-fach stärker exprimiert als in normalem Prostatagewebe. Im Gegensatz zum PSA- ist der PCA3-Wert vom Prostatavolumen unabhängig und scheint sogar mit der Größe des Karzinoms zu korrelieren.

    „Liegt der Wert deutlich über dem Cut-off von 35, steigt die Wahrscheinlichkeit für das Vorliegen eines Prostatakarzinoms und man sollte dem Patienten zu einer erneuten Biopsie raten“, erklärte Laible in Stuttgart. Doch auch für diesen Test werden die Kosten (ca. 300 Euro) von den gesetzlichen Krankenkassen momentan noch nicht übernommen.

  4. admin Says:

    November 23, 2010 — Watchful waiting or active surveillance are options in selected patients with benign prostatic hyperplasia (BPH) and prostate cancer, according to a review reported in the December issue of the International Journal of Clinical Practice.

    „…BPH and prostate cancer (CaP) are major sources of morbidity in older men,“ write J. Sausville and M. Naslund, from the University of Maryland School of Medicine in Baltimore. „Management of these disorders has evolved considerably in recent years. This article provides a focused overview of BPH and CaP management aimed at primary care physicians.“

    BPH may give rise to troublesome lower urinary tract symptoms and/ or acute urinary retention. Acute urinary retention may be associated with an increased risk for recurrent urinary tract infections; bladder calculi; and, occasionally, renal insufficiency. BPH may be managed with medications, minimally invasive therapies, and prostate surgery.

    First-line treatment in men presenting with lower urinary tract symptoms from BPH is typically pharmacotherapy with alpha-blockers or 5-alpha-reductase inhibitors. Alpha-blockers generally work within a few days by relaxing smooth muscle, whereas 5-alpha-reductase inhibitors may take 6 to 12 months to relieve urinary symptoms. The latter drug class blocks the conversion of testosterone to dihydrotestosterone, thereby shrinking hyperplastic prostate tissue.

    Malignant disease in men older than 50 years with lower urinary tract symptoms can largely be excluded by normal results on digital rectal examination, prostate-specific antigen (PSA) blood testing, and urinalysis. However, elevated PSA levels and/or a nodular prostate may be red flags for prostate cancer, and microscopic hematuria with urinary symptoms may suggest bladder cancer or prostate cancer.

    Prostate cancer is a highly prevalent condition, and outcomes may be better with early detection. Although 2 large clinical trials have recently been published supporting screening for prostate cancer, mass screening is still considered controversial.

    „The ageing of the population of the developed world means that primary care physicians will see an increasing number of men with BPH and CaP,“ the review authors write. „Close collaboration between primary care physicians and urologists offers the key to successful management of these disorders.“

    On the basis of a review of current literature regarding BPH and prostate cancer, the study authors note that despite increasing use of effective medical treatments, surgical intervention is still a valid option for many men. New technologies have emerged for surgical management.

    Open radical retropubic prostatectomy is still the oncologic reference standard, but other well-established surgical procedures include transurethral resection of the prostate as well as use of minimally invasive techniques. A new surgical technique for prostate cancer management, now under more widespread use, is robot-assisted prostatectomy.

    Other options for treatment of prostate cancer include radiation therapy, brachytherapy, high-intensity focused ultrasound, and cryotherapy. The review authors also note that not all men with prostate cancer necessarily need to be treated and that watchful waiting or active surveillance may be appropriate in some patients.

    „Various protocols exist for identifying low-risk CaP and some such patients may be offered active surveillance,“ the review authors write. „To mitigate the danger of under-grading, these patients typically undergo repeated prostate biopsies at predetermined intervals, and PSA levels and DRE [digital rectal examination] findings are monitored. If progression of disease (increased PSA, PSAV [PSA velocity], or discovery of higher grade or bulkier cancer on biopsy) occurs, definitive therapy is offered.“

    The review authors have disclosed no relevant financial relationships.

    Int J Clin Pract. 2010;64:1740-1745. Abstract

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