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Prostate cancer

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 5 Apr 2025
Last updated: 28 Jan 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
  • Northwest 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 testing
  • testosterone
  • LFTs
  • CBC
  • renal function
  • bone scan (technetium-99)
  • CT scan
  • MRI
  • prostate-specific membrane antigen (PSMA)-PET/CT
  • PSMA-PET/MRI
  • genetic and molecular 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: postexternal beam radiation 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.

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 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

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.

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-mMaking 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: prostate cancer
    • Salvage therapy for prostate cancer: AUA/ASTRO/SUO guideline
    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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