Prostate cancer

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 30 Apr 2025

Last updated: 12 May 2025

Prostate cancer is the second leading cause of cancer mortality in men in the US. It is most commonly reported in men ages >50 years.

Prostate-specific antigen testing and digital rectal exam are key diagnostic tools used in screening. Diagnosis is confirmed by prostate biopsy.

Management may be expectant or definitive (i.e., with curative intent).

In the US, overall 5-year survival rate is approximately 100% for local- and regional-stage prostate cancer, and approximately 38% for distant-stage prostate cancer.

Definition

A malignant tumor of glandular origin, situated in the prostate. It is most commonly reported in men aged over 50 years; the median age at diagnosis in the US is 67 years (based on data from 2017 to 2021).[1]

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 investigations

1st investigations to order

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

Full details

Investigations 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

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

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

Disclosures

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

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

Disclosures

PCW declares that he has no competing interests.

James Kearns, MD

Assistant Professor of Urology

NorthShore University HealthSystem

Chicago

Disclosures

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

References

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.

Key articles

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

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

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.Full text Abstract

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.Full text Abstract

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.Full text Abstract

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.Full text Abstract

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.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Benign prostatic hyperplasia
- Chronic prostatitis
More Differentials
Guidelines
- NCCN clinical practice guidelines in oncology: genetic/familial high-risk assessment breast, ovarian, pancreatic, and prostate
- NCCN clinical practice guidelines in oncology: prostate cancer early detection
More Guidelines
Patient information
Prostate cancer
Routine screening for prostate cancer
More Patient information
Calculators
Prostatism Symptom Score
More Calculators
Videos
Male urethral catheterization: animated demonstration
More videos
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Prostate cancer

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

very low-risk disease

low-risk disease

favorable intermediate-risk disease

unfavorable intermediate-risk disease

high-risk or very high-risk disease

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

Disclosures

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

Disclosures

Peer reviewers

Emma Alexander, MBBS

Disclosures

Peter Albertsen, MD

Disclosures

Patrick C. Walsh, MD

Disclosures

James Kearns, MD

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Calculators

Videos

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice