• from: oncology 󰒖

prostate cancer

• Abbreviations of prostate cancer 󰒗
• Localized Prostate Cancer
• Recurrent or Metastatic Prostate Cancer

Epidemiology and risk factors (NEJM 2003;349:366)

• Most common cancer in U.S. men; 2nd most common cause of cancer death in men
• Lifetime risk of prostate cancer dx ~16%; lifetime risk of dying of prostate cancer ~3%
• ↑ risk with ↑ age (rare if <45 y), in African Americans, ⊕ FHx, BRCA mutations

Clinical manifestations

• Most prostate cancers (78%) are asymptomatic and localized at diagnosis
• Metastatic dis. sx primarily from bone mets: bone pain, spinal cord compression, cytopenias

Screening (JAMA 2014;311:1143; Lancet 2014;384:2027)

• PSA: 4 ng/mL cut point neither Se nor Sp; can ↑ with BPH, prostatitis, acute retention, after bx or TURP, and ejaculation (no significant ↑ after DRE, cystoscopy); 15% of men >62 y w/ PSA <4 & nl DRE have bx-proven T1 cancer (NEJM 2004;350:2239)
• Digital rectal exam no longer recommended due to limitations, no mortality benefit
• ACS rec: ≥50 y (or ≥45 y AA or ⊕ FHx) discuss PSA screening, informed decision making
• USPSTF (JAMA 2018;319:1901) rec discuss pros/cons w/ Pt (no ↓ in prostate ca-related mort.)

Diagnostic evaluation, staging, and treatment (NCCN Guidelines v1.2022)

• Transrectal ultrasound (TRUS) guided biopsy (6–12 cores)
• Multiparametric MRI (± endorectal coil): improves detection (NEJM 2018;378:1767)
• 220706-2210-gleason score & grade group (histology): Gleason score determines Grade Group. 1 = best → 5 = worst. Group 1: 3+3=6 (most common histologic pattern is 1st #, next is 2nd #), Group 2: 3+4=7, Group 3: 4+3=7, Group 4: 4+4=8, Group 5: all higher.

Risk Stratification and Treatment of Localized Prostate Cancer

Risk-Stratification-andreatment-of-Localized-Prostate

Recurrent/Metastatic Prostate Cancer

Biochemical recurrence in prostate cancer (BCR)

Castration-resistant prostate cancer (CRPC)