Overview
Definition
A malignant neoplasm of the prostate gland.
Epidemiology
The most common non-skin cancer in men. Very high lifetime risk, but many cases are slow-growing and indolent.
Etiology & Risk Factors
- Adenocarcinoma arising mostly from the peripheral zone of the prostate (which is why it can be felt on DRE).
- Risk factors: Advancing age, African American descent, family history, BRCA mutations.
Clinical Symptoms
- Often asymptomatic in early stages (found on screening)
- Obstructive urinary symptoms (similar to BPH, but less common as initial presentation since cancer is in the periphery)
- Bone pain (back or pelvis) if metastasis has occurred
Clinical Approach
Diagnosis
- Screening: PSA (Prostate-Specific Antigen) - controversial, requires shared decision-making
- Digital Rectal Exam (DRE): Hard, nodular, asymmetrical prostate
- Transrectal Ultrasound (TRUS) guided core needle biopsy (Definitive diagnosis)
- Gleason Score: Pathologic grading system that determines aggressiveness (Scale of 6 to 10)
Management
- Low-risk/Indolent: Active Surveillance (regular PSA and biopsies)
- Localized disease: Radical Prostatectomy or Radiation Therapy (External beam or Brachytherapy)
- Metastatic disease: Androgen Deprivation Therapy (Leuprolide, Flutamide) to starve the tumor of testosterone
Complications
- Metastasis (osteoblastic bony lesions in the lumbar spine)
- Erectile dysfunction and urinary incontinence (common complications of prostatectomy or radiation)