By Jens Erik Fenstad, Ivan T. Frolov, Risto Hilpinen (eds.)
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40 Prostate Cancer 4. Both a palpable nodule and a rising serum PSA level can be signs of local disease recurrence (grade B recommendation). 5. Detection of local recurrence by TRUS and biopsy is only recommended if it will affect the treatment plan. In most cases, TRUS and biopsy are not necessary before second-line therapy (grade B recommendation). 6. Metastasis may be detected by pelvic CT/MRI or bone scan. In asymptomatic patients, these examinations may be omitted if the serum PSA level is less than 30 ng/mL, but data on this topic are sparse (grade C recommendation).
2. The diagnosis of CaP depends on histopathological (or cytological) confirmation (grade B recommendation). Biopsy and further staging investigations are only indicated if they affect the management of the patient (grade C 34 Prostate Cancer recommendation). 3. Transrectal ultrasound guided systemic biopsies is the recommended method in most cases where prostate cancer is suspected. A minimum of 6-10 systemic laterally directed cores are recommended, perhaps more cores in larger glands (grade B recommendation).
If the tumour is completely resected, the thickness of the surgical margin (> 1 mm) does not correlate with the likelihood of local recurrence. If RCCs of larger size are treated with nephron-sparing surgery, follow-up should be intensified as there is an increased risk of intra-renal recurrences. Laparoscopic nephrectomy Laparoscopic radical nephrectomy has a lower morbidity compared with open surgery. The laparoscopic approach allows early control of the renal vessels before tumour manipulation, wide specimen mobilization external to Gerota’s fascia, avoidance of specimen damage or rupture and intact specimen extraction.