Summary
Definition
History and exam
Other diagnostic factors
- nocturia
- urinary frequency
- urinary hesitancy
- dysuria
- abnormal digital rectal exam
- hematuria
- weight loss/anorexia
- lethargy
- bone pain
- palpable lymph nodes
Risk factors
- age >50 years
- black ethnicity
- North American or northwest European descent
- family history of prostate cancer
- high levels of dietary fat
Diagnostic investigations
1st investigations to order
- serum prostate-specific antigen (PSA)
- testosterone
- LFTs
- CBC
- renal function
- prostate biopsy
Investigations to consider
- bone scan
- plain radiographs
- pelvic CT scan
- pelvic MRI/endorectal MRI
Emerging tests
- urinary biomarkers
- serum 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
Contributors
Authors
Radiation Oncologist
Richmond Radiation Oncology Associates
Bon Secours Cancer Institute
Richmond
VA
Disclosures
TJW declares that he is the principal investigator of an R-21 NIH research grant investigating the tumor-mediated immune responses in African-American men with prostate cancer.
Professor
Department of Radiation Oncology
University of Texas MD Anderson Cancer Center
Houston
TX
Disclosures
MSA declares that he has no competing interests.
Peer reviewers
Clinical Oncology Registrar
St Luke's Cancer Centre
Royal Surrey Hospital
Guildford
Surrey
UK
Disclosures
EA has received consultation fees from the following organizations during the past 3 years: 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.
Medical Director
UConn Medical Group
University of Connecticut Health Center
Farmington
CT
Disclosures
PA declares that he has no competing interests.
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