Summary
Definition
History and exam
Key diagnostic factors
- elevated prostate-specific antigen (PSA)
Other diagnostic factors
- abnormal digital rectal exam (DRE)
- nocturia
- urinary frequency
- urinary hesitancy
- dysuria
- hematuria
- 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 tests
1st tests to order
- serum prostate-specific antigen (PSA)
- prebiopsy multiparametric MRI
- prostate biopsy
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
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: 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.
Differentials
- Benign prostatic hyperplasia
- Chronic prostatitis
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