Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- elevated prostate-specific antigen (PSA)
Outros fatores diagnósticos
- abnormal digital rectal exam (DRE)
- nocturia
- urinary frequency
- urinary hesitancy
- dysuria
- hematuria
- hematospermia
- weight loss/anorexia
- lethargy
- bone pain
- palpable lymph nodes
Fatores de risco
- 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
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- serum prostate-specific antigen (PSA)
- prebiopsy multiparametric MRI
- prostate biopsy
Investigações a serem consideradas
- 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
Novos exames
- multimodal artificial intelligence (MMAI) tools
Algoritmo de tratamento
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
Colaboradores
Autores
Timothy J. Wallace, MD, PhD
Radiation Oncologist
Department of Radiation Oncology
Virginia Commonwealth University
Richmond
VA
Declarações
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
Declarações
MSA serves on the Government Relations Committee for the American Society for Radiation Oncology.
Revisores
Emma Alexander, MBBS
Clinical Oncology Registrar
St Luke's Cancer Centre
Royal Surrey Hospital
Guildford
Surrey
UK
Declarações
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
Declarações
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
Declarações
PCW declares that he has no competing interests.
James Kearns, MD
Assistant Professor of Urology
NorthShore University HealthSystem
Chicago
IL
Declarações
JK declares that he has no competing interests. JK is an author of an article cited in the topic.
Créditos aos pareceristas
Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.
Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: prostate cancer [internet publication].Texto completo
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: prostate cancer early detection [internet publication].Texto completo
Walz J, Attard G, Bjartell A, et al. Local and locoregional prostate cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2026 Apr;37(4):453-69.Texto completo Resumo
Taplin ME, Riaz IB, Rumble RB, et al. Systemic therapy in patients with metastatic castration-resistant prostate cancer: ASCO living guideline, version 2026.1. J Clin Oncol. 2026 Feb 20;44(6):e1-4.Texto completo Resumo
Fizazi K, Attard G, Azad AA, et al. Advanced and metastatic prostate cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 10 Feb 2026.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Benign prostatic hyperplasia
- Chronic prostatitis
Mais Diagnósticos diferenciaisDiretrizes
- Systemic therapy in patients with metastatic castration-resistant prostate cancer: ASCO living guideline
- Advanced and metastatic prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up
Mais DiretrizesFolhetos informativos para os pacientes
Prostate cancer
Routine screening for prostate cancer
Mais Folhetos informativos para os pacientesCalculadoras
International Prostatism Symptom Score (IPSS)
PASS risk calculators
Mais CalculadorasVideos
Male urethral catheterization: animated demonstration
Mais vídeos
Conectar-se ou assinar para acessar todo o BMJ Best Practice
O uso deste conteúdo está sujeito ao nosso aviso legal