Prostate cancer

Last reviewed: 6 Jan 2023
Last updated: 25 Nov 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • elevated prostate-specific antigen (PSA)
More key diagnostic factors

Other diagnostic factors

  • abnormal digital rectal examination (DRE)
  • nocturia
  • urinary frequency
  • urinary hesitancy
  • dysuria
  • haematuria
  • weight loss/anorexia
  • lethargy
  • bone pain
  • palpable lymph nodes
Other diagnostic factors

Risk factors

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

Diagnostic investigations

1st investigations to order

  • serum prostate-specific antigen (PSA)
  • prebiopsy multiparametric MRI
  • prostate biopsy
More 1st investigations to order

Investigations to consider

  • prebiopsy biomarker testing
  • testosterone
  • LFTs
  • FBC
  • renal function
  • bone scan (technetium-99)
  • plain radiographs
  • CT scan
  • MRI
  • prostate-specific membrane antigen (PSMA)-PET/CT
  • PSMA-PET/MRI
  • genetic and molecular testing
More investigations to consider

Emerging tests

  • TMPRSS2-ERG gene fusions

Treatment algorithm

ACUTE

very low-risk disease

low-risk disease

favourable intermediate-risk disease

unfavourable intermediate-risk disease

high-risk or very high-risk disease

ONGOING

non-metastatic disease: post-radical prostatectomy

non-metastatic disease: post-external beam radiotherapy

non-metastatic 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.

Peer reviewers

Emma Alexander, MBBS

Clinical Oncology Registrar

St Luke's Cancer Centre

Royal Surrey Hospital

Guildford

Surrey

UK

Disclosures

EA has received consultation fees from the following organisations: 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

Disclosures

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

Disclosures

PCW declares that he has no competing interests.

James Kearns, MD

Assistant Professor of Urology

NorthShore University HealthSystem

Chicago

IL

Disclosures

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

  • Differentials

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  • Guidelines

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