Prostate cancer
Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- elevated prostate-specific antigen (PSA)
Other diagnostic factors
- abnormal digital rectal examination (DRE)
- nocturia
- urinary frequency
- urinary hesitancy
- dysuria
- haematuria
- weight loss/anorexia
- lethargy
- bone pain
- palpable lymph nodes
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
Diagnostic investigations
1st investigations to order
- serum prostate-specific antigen (PSA)
- testosterone
- LFTs
- FBC
- renal function
- prostate biopsy
Investigations to consider
- bone scan
- plain radiographs
- pelvic CT scan
- pelvic MRI/endorectal MRI
Emerging tests
- genetic biomarkers
- 18F-sodium fluoride PET/CT and 11C-choline PET/CT
- prostate cancer antigen 3 (PCA3) assay
- TMPRSS2-ERG gene fusions
- prostate health index (PHI)
- 4Kscore test
Treatment algorithm
very low-risk disease
low-risk disease
favourable intermediate-risk disease
unfavourable intermediate-risk disease
high-risk or very high-risk disease
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 is the principal investigator of an R-21 NIH research grant investigating the tumour-mediated immune responses in African-American men with prostate cancer.
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.
Differentials
- Benign prostatic hyperplasia
- Chronic prostatitis
More DifferentialsGuidelines
- Initial management of non-castrate advanced, recurrent or metastatic prostate cancer
- Advanced prostate cancer: AUA/ASTRO/SUO guideline
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