Tiivistelmä

Eturauhassyöpäepäily perustuu yleensä oireettomalta tai virtsaoireiselta mieheltä otetun verinäytteen ­PSA-arvon poikkeavuuteen. Diagnoosi perustuu valtaosin eturauhasen paksuneulabiopsian histologiaan. Hoito suunnitellaan syövän riskiluokituksen mukaan potilaan perussairaudet ja odotettavissa oleva ­elinikä huomioiden. Tuseerauslöydöksen ja PSA-tason lisäksi monimuuttujainen magneettikuvaus kohdennettuine neula­näytteineen, kehittyvät biomarkkerit ja riskilaskurit ovat hyödyllisiä diagnostiikassa ja riskin arvioinnissa.

Summary

Prostate cancer is the most frequently diagnosed cancer in Finland and the second most common cause of cancer death among Finnish males. An abnormal PSA blood test from an asymptomatic man or a man seeking help for urinary symptoms is the usual reason for further diagnostic tests. A diagnosis based on symptoms of metastatic cancer is less frequent.

The diagnosis is mainly based on histological analysis of transrectal needle biopsies. To avoid diagnosis of clinically insignificant cancers among men with slightly abnormal PSA values (< 10 µg/l), further risk stratification with other biomarkers, risk calculators or multiparametric magnetic resonance imaging (MRI) is suggested before biopsy.

Most clinically significant cancers are identified with MRI, with the option to perform targeted biopsies of abnormal lesions. This improves the risk classification of cancer. With the PSA test both clinically insignificant and aggressive cancers are diagnosed. The treatment decisions are based on the risk classification of the cancer. Low risk cancers are suggested to be treated primarily by active surveillance.