Last reviewed: 27 Sep 2021
Last updated: 29 Apr 2021

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 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

  • 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

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 tumor-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 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.

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