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Prostate cancer

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 23 Sep 2025
Last updated: 12 May 2025

Summary

Definition

History and exam

Key diagnostic factors

  • elevated prostate-specific antigen (PSA)
Full details

Other diagnostic factors

  • abnormal digital rectal exam (DRE)
  • nocturia
  • urinary frequency
  • urinary hesitancy
  • dysuria
  • hematuria
  • weight loss/anorexia
  • lethargy
  • bone pain
  • palpable lymph nodes
Full details

Risk factors

  • age >50 years
  • black ethnicity
  • Northern European, Caribbean, Australian, New Zealand, North American, and Southern African populations
  • positive family history/genetic factors
  • high levels of dietary fat
Full details

Diagnostic tests

1st tests to order

  • serum prostate-specific antigen (PSA)
  • prebiopsy multiparametric MRI
  • prostate biopsy
Full details

Tests to consider

  • prebiopsy biomarker tests and risk calculators
  • testosterone
  • LFTs
  • CBC
  • renal function
  • bone scan (technetium-99)
  • CT scan
  • MRI
  • prostate-specific membrane antigen (PSMA)-PET/CT
  • PSMA-PET/MRI
  • tumor molecular and genetic testing
  • genetic evaluation and germline testing
Full details

Treatment algorithm

ACUTE

very low-risk disease

low-risk disease

favorable intermediate-risk disease

unfavorable intermediate-risk disease

high-risk or very high-risk disease

ONGOING

nonmetastatic disease: postradical prostatectomy

nonmetastatic disease: postradiation therapy

nonmetastatic disease: castration-resistant

metastatic disease: castration-sensitive

metastatic disease: castration-resistant

Contributors

Authors

Timothy J. Wallace, MD, PhD

Radiation Oncologist

Department of Radiation Oncology

Virginia Commonwealth University

Richmond

VA

Disclosures

TJW declares that he has no competing interests.

Mitchell S. Anscher, MD, FACR, FACRO, FASTRO

Professor Emeritus

Department of Radiation Oncology

Virginia Commonwealth University

Richmond

VA

Disclosures

MSA declares that he has no competing interests.

同行评议者

Emma Alexander, MBBS

Clinical Oncology Registrar

St Luke's Cancer Centre

Royal Surrey Hospital

Guildford

Surrey

UK

利益声明

EA has received consultation fees from the following organizations: Blue Cross/Blue Shield Association, Sanofi-Aventis, Ferring Pharmaceuticals, Pfizer Corporation, American Urological Association, National Institutes of Health, Accreditation Council for Graduate Medical Education, Royal Hallamshire Hospital, Hartford County Medical Association. EA owns shares in Pfizer Pharmaceuticals, Johnson and Johnson, and General Electric Corporation.

Peter Albertsen, MD

Medical Director

UConn Medical Group

University of Connecticut Health Center

Farmington

CT

利益声明

PA declares that he has no competing interests.

Patrick C. Walsh, MD

University Distinguished Service Professor of Urology

Professor Emeritus of Urology

Brady Urological Institute

Johns Hopkins University

Baltimore

MD

Раскрытие информации

PCW declares that he has no competing interests.

James Kearns, MD

Assistant Professor of Urology

NorthShore University HealthSystem

Chicago

IL

Раскрытие информации

JK declares that he has no competing interests. JK is an author of an article cited in the topic.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: prostate cancer [internet publication].Полный текст

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: prostate cancer early detection [internet publication].Полный текст

Parker C, Castro E, Fizazi K, et al. Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020 Sep;31(9):1119-34.Полный текст  Аннотация

Morgan SC, Hoffman K, Loblaw DA, et al. Hypofractionated radiation therapy for localized prostate cancer: an ASTRO, ASCO, and AUA evidence-based guideline. J Clin Oncol. 2018 Oct 11;36(34):JCO1801097.Полный текст  Аннотация

Morgan TM, Boorjian SA, Buyyounouski MK, et al. Salvage therapy for prostate cancer: AUA/ASTRO/SUO guideline part I: introduction and treatment decision-making at the time of suspected biochemical recurrence after radical prostatectomy. J Urol. 2024 Apr;211(4):509-17.Полный текст  Аннотация

Morgan TM, Boorjian SA, Buyyounouski MK, et al. Salvage therapy for prostate cancer: AUA/ASTRO/SUO guideline part II: treatment delivery for non-metastatic biochemical recurrence after primary radical prostatectomy. J Urol. 2024 Apr;211(4):518-25.Полный текст  Аннотация

Morgan TM, Boorjian SA, Buyyounouski MK, et al. Salvage therapy for prostate cancer: AUA/ASTRO/SUO guideline part III: salvage therapy after radiotherapy or focal therapy, pelvic nodal recurrence and oligometastasis, and future directions. J Urol. 2024 Apr;211(4):526-32.Полный текст  Аннотация

Статьи, указанные как источники

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