Prostate cancer
Prostate cancer is the most commonly diagnosed cancer in men, usually found through an elevated PSA in an asymptomatic patient, with risk stratified by PSA, Grade Group (Gleason score), and TNM stage. Localized low-risk disease is often managed with active surveillance, while higher-risk and metastatic disease require radiation, surgery, or androgen deprivation therapy escalated through castrate-sensitive and castrate-resistant phases.
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What this article covers
- Overview
Prostate cancer is one of the most commonly diagnosed cancers in men in the United States, almost always adenocarcinoma arising in the peripheral zone of the prostate gland.
- Epidemiology
Incidence rises sharply after age 40 years; prostate cancer is rarely diagnosed before that age.
- Risk factors
Age over 40 years, with incidence increasing significantly beyond that threshold.
- Pathophysiology
Adenocarcinoma arising from prostatic glandular epithelium, most often in the peripheral zone, which is why DRE (palpating mainly the posterior peripheral zone) can detect a nodule.
- Clinical features
Asymptomatic PSA elevation is the dominant presentation, identified during screening in a man with no symptoms attributable to the cancer.
- Differential diagnosis
Benign prostatic hyperplasia: causes lower urinary tract symptoms and can mildly elevate PSA, but the prostate is typically diffusely, smoothly enlarged rather than nodular, and biopsy is negative for malignancy.
- Diagnosis
The diagnosis is confirmed by transrectal ultrasound-guided prostate biopsy showing adenocarcinoma, prompted by a persistently elevated serum PSA or an abnormal DRE; a suspected PSA elevation is…
- Management
First, assign a risk category and treat localized disease accordingly; for very-low-risk or low-risk disease with at least 10 years life expectancy, offer active surveillance: DRE no more than every…
- Complications
Metastatic spread to bone, producing pain, pathologic fracture, and spinal cord compression in advanced disease.
- Prognosis
Excellent for organ-confined, low-risk disease: up to 97% 15-year metastasis-free survival on active surveillance, with no 10-year survival difference among active surveillance, surgery, and…
- Prevention
No routine population PSA screening is recommended; for men aged 55 to 69 years, PSA-based screening is an individualized decision after discussing benefits and harms, with an estimated benefit of…
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