Prostate Cancer

Excerpt

Prostate cancer is the most commonly diagnosed malignancy in men globally and the fifth leading cause of cancer-related deaths in men. In 2020, there were 1,414,249 newly diagnosed cases and 375,000 deaths worldwide annually due to this disease. Globally, prostate cancer is the most commonly diagnosed malignancy in more than 50% of countries (112 out of 185).

Fortunately, most prostate cancers tend to grow slowly and are low-grade with relatively low risk and limited aggressiveness. There are no initial or early symptoms in most cases, but late symptoms may include fatigue due to anemia, bone pain, paralysis from spinal metastases, and renal failure from bilateral ureteral obstruction.

Diagnosis is primarily based on prostate-specific antigen (PSA) testing and transrectal ultrasound-guided (TRUS) prostate tissue biopsies, although PSA testing for screening remains controversial.

Newer diagnostic modalities include free and total PSA levels, PCA3 urine testing, Prostate Health Index (PHI) scoring, the 4K test, exosome testing, genomic analysis, magnetic resonance imaging (MRI), Prostate Imaging–Reporting and Data System (PI-RADS) scoring, and MRI-TRUS fusion-guided biopsies.

When the cancer is limited to the prostate, it is considered localized and potentially curable. If the cancer has spread to the bones or other areas outside the prostate, treatment options include pain medications, bisphosphonates, rank ligand inhibitors, hormonal therapy, chemotherapy, radiopharmaceuticals, immunotherapy, focused radiation, and other targeted therapies. Outcomes depend on age, associated health problems, tumor histology, and the extent of cancer.