Jump to content

Prostate Cancer

Original Editors - Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Top Contributors - Taylor Carta, Devin Conway, Angeliki Chorti, Shaimaa Eldib, Kim Jackson, Lucinda hampton, Evan Thomas, Vidya Acharya, Tony Lowe, Nicole Sandhu, Elaine Lonnemann, Mandy Roscher, Jess Bell, Kirenga Bamurange Liliane, Tarina van der Stockt, Venugopal Pawar, WikiSysop, 127.0.0.1, Ewa Jaraczewska, Rosie Swift and Rachael Lowe

Introduction

Definition

Male pelvic anatomy.

Prostate cancer (PCa) affects the cells of the prostate gland, the part of the male reproductive system located at the base of the penis and below the bladder. [1] For a quick reference of male anatomy, you can check the male anatomy figure. You can also can visit the Male Pelvic Anatomy page for a detailed description of male anatomy.

2025 ICD-10 code

  • C61: Malignant neoplasm of prostate [2]

2025 ICD-11 codes

  • 2C82: Malignant neoplasms of prostate
    • 2C82.0: Adenocarcinoma of prostate.
    • 2C82.Y: Other specified malignant neoplasms of prostate.
    • 2C82.Z: Malignant neoplasms of prostate, unspecified.
  • 2E02: Malignant neoplasm metastasis in other or unspecified urinary system organs
    • Metastatic carcinoma in the prostate
  • 2E06: Malignant neoplasm metastasis in male genital organs
  • 2F34: Benign neoplasm of male genital organs
  • 2F77: Neoplasms of uncertain behaviour of male genital organs
  • 2F97: Neoplasms of unknown behaviour of male genital organs
  • XH4PB1: Acinar adenocarcinoma of prostate
  • XH5C49: Prostatic intraepithelial neoplasia, grade III
  • XH4ZC3: Basal cell carcinoma of the prostate

[3]

Epidemiology

PCa is the most commonly diagnosed organ cancer in men and the second leading cause of male cancer death in the United States. [4] [5] [6] In Europe, PCa is the third most diagnosed cancer after breast and colorectal. [7] A quarter of European men with PCa who are treated conservatively require hospitalisation withing the first year of their diagnosis, but as time goes on, seeking for therapies for PCa decreases despite PCa progression. [8]

PCa is reported to be more widespread in the developed world; however, more men are dying because of PCa in LMICs. [9][10] The overall 5-year survival rate for localised PCa is almost 100%; however, patients with PCa may die of the disease in the more advanced stages. [11]

Although 1 in 7 men are reported to have a lifetime risk of PCa globally, this statistic may be even higher (1 in 8) depending on various risk factors according to the American Cancer Society. [12] In the event of PCa metastasis, spreading to the viscera alone and/or bone is a negative prognostic factor and is reported as a sign of a more aggressive metastatic disease. [13]

PCa has lately become a significant issue due to the fact that it has become so prevalent. According to a 2023 report, more men are diagnosed with advanced PCa and metastasis; this rise may be partly due to recommendations against screenings on healthy men. [14]

It is projected that rates of PCa will continue to increase through to 2025, particularly in men aged over 69 years. [15]

Etiology/Pathogenesis/Risk Factors

The cause of PCa is not precisely known; however, there are several known risk factors that have been shown to indicate an increase in the risk of developing this type of cancer. [16][17]

Non Modifiable Risk Factors

Advancing Age

Most men who acquire PCa are 65 years or older. It is very rare to develop PCa before 45 years of age. [12] More than 80% of men will develop PCa by age 80. However, in this age group, it will probably be slow growing, lower grade, relatively harmless and have little impact on their survival. [18] Although most PCas occur in older men, when it occurs in younger men, it can present with some unique challenges e.g. aetiology, disease agressiveness, long-term treatment consequences that warrant further attention. [19]

For an overview on the effects of advancing ageing on various elements of the genitourinary system including the prostate gland, you can visit the page Ageing and Genitourinary System.

Race/Ethnicity

In the United States, PCa is disproportionately more common in African Americans by more than double the rate in the general population; it is less common in men of Asian and Hispanic descent than in Caucasian. [20] Race and ethnicity risk factors may be influenced by environmental and/or dietary factors in some cases since it has been found that Asians who immigrated to the USA have approximately half the risk of PCa when compared to their US born Asian-descendant counterparts. [21] Timing of presentation, disease agressiveness, and mortality rates in African-American men are more than twice as high as in any other racial group. [20][22]

Geography

PCa diagnoses are more frequent in North America, northwestern Europe, Australia, and on the Caribbean islands, and less common in Asia, Africa, Central America, and South America.[23]

Family History

There is an increased risk of developing prostate cancer if there is a family history of the disease, and the risk of disease and mortality increases (2 to 4 -fold) the more first degree relatives that have been affected. [24]

Individual Characteristics

Tall men and vertex pattern baldness, has been indicated as risk factors for PCa. [25]

Gene Mutations

Genetic single nucleotide polymorphism (SNPs)

SNPs very common but low impact when looking at the risk of developing PCa. [25] There are 269 individual SNPs contributing to having PCa. [26] Each individual SNP may have a low impact on PCa risk, however, when adding the effects of multiple alleles, the risk of developing PCa raises substantially causing a large proportion of hereditary PCa. [27]

Germline mutations

Pathogenic germline mutations in the BRCA1, BRCA2, HOXB13, CHEK2, ATM, NBS1 genes and those linked to Lynch syndrome may increase the risk of PCa. [25]

Viruses

Men positive for human papillomavirus-16 [28] and gonorrhoea has been significantly associated with an increased incidence of PCa. [29]

Hormones

A possible correlation between elevated levels of luteinising hormone and of testosterone and more specifically, dihydrotestosterone with a mild increase in the risk of PCa has been indicated, [30] but firm conclusions are still pending due to the conflicting and complex relationship between androgens and prostate cancer.

Modifiable Risk Factors

Lifestyle risk factors that are modifiable are considered key to structuring preventative strategies for PCa. [31] To date, there are no established preventative strategies based on these factors for PCa.

Diet

Reported dietary risk factors for PCa are meals rich in red well done meat, saturated fats, processed food and diary products (calcium intake) - especially where advanced PCa is concerned. [32] When combined with a low dietary intake in vegetables and fruits, and therefore vitamins and minerals, the development of PCa is thought to be supported by mechanisms that stimulate cancer cell proliferation and angiogenesis. [33] However, although a number of dietary factors have been studied, quality of evidence remains low. [34]

Obesity

Being overweight or obesity (by body mass index, waist circumference, and waist–hip ratio) in men has been linked to higher rates of advanced PCa and mortality. [31][35]

Occupational Exposures

Increased occupational physical activity seems to lower PCa risk; on the contrary, occupational exposure to chemical substances (herbicides, pesticides, and toxic combustible products), cadmium, [36] and other metals increases the risk of having PCa. [25]

Smoking

Cigarette smoking has been correlated with greater risk of PCa death, aggressiveness, and overall worse prognosis, even after quitting smoking. [37][38]

Diagnostic Evaluation

Clinical Presentation

The clinical presentation of PCa may be nonspecific and may also share characteristics seen in other prostate-related disease processes such as Benign Prostatic Hyperplasia (BPH) or Prostatitis. [39] This overlap reveals the complex interrelation between these entities and poses a significant diagnostic challenge often leading to further investigation. It must also be noted that early PCa may be asymptomatic; this is why regular screening in asymptomatic men is necessary to avoid increase in diagnoses of advanced PCa.[14]

Diagram demonstrating how prostate cancer can cause urinary issues
Diagram demonstrating how prostate cancer can cause urinary issues

Examples of clinical signs and symptoms in PCa:

  • Urinary retention or other urinary complaints
  • Low back pain, inner thigh or perineal pain or stiffness
  • Hematuria
  • Blood in semen 
  • Suprapubic or pelvic pain/discomfort
  • Sexual dysfunction

PCa metastases are not rare, and possible spreading sites were traditionally the bone (spine, pelvis, and ribs are the most common sites), [40] following with the lymph nodes, liver, and lungs; [41] however, in recent years, reports of atypical sites of metastasis have been increasing. [42] You can find such cases in the case reports / case studies section of this page. This novel atypical metastasis pattern may indicate the need for other investigation routes to be included in the usual clinical examination.

Manifestations of metastasised PCa may include:

  • Sciatica and lumbar pain
  • Bone pain and lower extremity pain
  • Lymphoedema of the groin or lower extremities 
  • Neurological changes, changes in bowel or bladder function e.g. from spinal cord compression
  • Anaemia
  • Weight loss and loss of appetite
  • Melena
  • Sudden moderate to high fever, chills

Screening and Early Detection

Prostate-Specific Antigen (PSA) Test

This is a blood test used to test for elevated serum levels of a prostate-specific antigen called PSA, and this may occur with both benign and malignant conditions of the prostate. [43] PSA testing for PCa screening has not received universal acceptance, but its insights into the extent of PCa malignancy, disease progression, recurrences, and treatment response are considered beyond doubt.[43]

The risk of disease may increase as the PSA level increases; however, a normal level of PSA has not been universally determined. [43] Single cut-off points for PSA levels may lead to overtreatment of PCa cases; adding to this, age-and prostate-size related differences, inter- and intra-personal variations seem to complicate even further the early detection of PCa. [44]

For example, according to the American Cancer Society, if PCa develops, the PSA levels may typically increase past 4 ng/mL of blood:

             -PSA level between 4 and 10: 25% chance of having PCa

             -PSA greater than 10: over 50% chance of having PCa

             -Approximately 15% of men with a PSA below 4 will be positive for PCa when biopsied

[45]

Up to now, the U.S. Preventive Services Task Force [46] recommended against PSA-based screening for PCa due to the test often producing false positives and overdiagnosis, which does not lead to any further clinical advantage from proceeding diagnostic tests or treatment. [47] This recommendation is considered controversial and is currently in the process of being reviewed according to the U.S. Preventive Services Task Force website.[46]

Refinements to PSA prescription and interpretation that takes into account age and genetic factors, risk and age-based cut-off levels, PSA density, percentage free PSA, and PSA velocity have been proposed and may result in better screening and diagnosis of PCa. [44]

Digital Rectal Examination (DRE)

PCa is mostly observed in the periphery of the prostate which why it is often palpable during a digital rectal examination (DRE). [48] A DRE is a medical examination in which the doctor inserts a (gloved, lubricated) finger into the rectum to allow the ability to palpate the back of the prostate gland and feel possible abnormalities such as cancers or bumps. [49]Although DRE is a commonly performed screening procedure for PCa, there is limited data to support its use in primary care. [49] Indeed, most patients diagnosed with PCa may have abnormal PSA levels, but normal DRE results making the DRE less sensitive in early detection of PCa. [43] Possibly DRE detection is more relevant for large enough abnormalities to be felt by the examining finger, and peripheral areas thus omiting other problematic parts of the prostate. Nevertheless, this test may still be included when combined with PSA in screening but this option requires further investigation.[50]

PCa often grows slowly; therefore, men without symptoms of prostate cancer who do not have a 10-year life expectancy may not be screened because these men may not benefit as much as younger men. [45] However, overall health status, not just age, should be considered when making decisions, and patients should talk to their healthcare provider about the pros and cons of being tested and treated for PCa. [51]

You can check this video outlining common PCa screening options for men:

[52]

Other Diagnostic Tools

Imaging

  • Magnetic Resonance Imaging (MRI) or PET-MRI
  • Transrectal ultrasound and ultrasound-based techniques
  • Prostate-specific membrane antigen (PSMA)
  • Positron emission tomography/Computed tomography (PET/CT)
  • Bone scintigraphy (for bone metastases)

[53]

Blood Biomarkers

  • PHI
  • 4K score
  • IsoPSA
  • Stockholm3
  • Proclarix

[53]

Urine Biomarkers

  • PCA3
  • SelectMDX
  • MyProstateScore (MPS/MPS2)
  • ExoDX

[53]

Biopsy - Gleason Score

The diagnosis of PCa is established via a biopsy of the prostate gland. [54] Biopsy is usually indicated for individuals who have elevated PSA levels and/or irregularity or nodule during DRE; however, globally, selected diagnostic procedures leading to the decision for a biopsy may depend on various factors such as proposed national protocols, availability, expertise, and resources. [55]

The biopsy procedure involves small piece of the prostate gland being removed and examined under a microscope for cancer cells. If cancer cells are found then a Gleason score will be used to grade PCa from the biopsy. [56] The Gleason score indicates how likely the cancer is to spread. However, its grading system has been variable even among experienced pathologists. [56]The score may range from 2–10, the lower the score the less likely it is that cancer will spread. [56]

False-negative results often occur (e.g. cancer may be present in patches within the gland that are difficult to find); therefore, multiple biopsies may be done before PCa can be detected and confirmed, although indications and ideal number of repetitions remain unclear. [57] [58] Even with multiple biopsies, the detection rate may be low and is reported to be higher only in younger patients, patients with high PSA levels, PSA density and Gleason scores, as well as patients with smaller prostates, lower free/total PSA ratios. [59]

Classification and Staging

PCa classification aims to group patients with similar clinical outcome and prognosis, and as a result, similar recommendations for treatment. The most commonly used classification systems is the Tumour, Node, Metastasis (TNM) classification [60] but the European guidelines also propose the EAU risk group classification based on biochemical recurrence (BCR) after radical prostatectomy or external beam radiotherapy.[61]

TNM Classification System [60]
T - Primary Tumour (stage based on digital rectal examination only)
Tx Primary tumour cannot be assessed
T0 No evidence of primary tumour
T1 Clinical inapparent tumour that is not palpable
T1a Tumour incidental histological finding in 5% or less of tissue resected
T1b Tumour incidental histological finding in more than 5% of tissue resected
T1c Tumour identified by needle biopsy (increased PSA levels)
T2 Tumour that is palpable and confined within the prostate
T2a Tumour involves one half of one lobe or less
T2b Tumour involves more than half of one lobe but not both
T2c Tumour involves both lobes
T3 Tumour extends palpably through the prostatic capsule
T3a Extracapsular extension (unilateral or bilateral)
T3b Tumour invades seminal vesicle(s)
T4 Tumour is fixed or invades adjacent structures other than seminal vesicle(s)
N - Regional (pelvic) Lymph Nodes
Nx Regional lymph nodes can't be assessed
N0 No regional lymph nodes metastasis
N1 Regional lymph node metastasis
M - Distant Metastasis
M0 No distant metastasis
M1 Distant metastasis
M1a Non-regional lymph node(s)
M1b Bone(s)
M1cOther site(s)
EAU risk groups for biochemical recurrence of localised and locally-advanced prostate cancer (based on systematic biopsy) [61]
Low risk Intermediate risk High risk
Favourable Unfavourable
ISUP grade 1 and PSA < 10 ng/mL and cT1-2a ISUP grade 2 and PSA < 10 ng/mL and cT1-2b

or ISUP grade 1 and PSA 10-20 ng/mL and cT1-2b or ISUP grade 1 and PSA < 10 ng/mL and cT2b

ISUP grade 2 and PSA 10-20 ng/mL and cT1-2b

or ISUP grade 3 and cT1-2b

ISUP grade 4/5

or PSA > 20 ng/ml or cT2c

cT3-4* and/or cN+

any ISUP grade* any PSA

Localised Localised Localised Localised Locally advanced


Staging aims to determine if PCa is local or advanced and may take account of the extent of the tumour, the involvement of lymph nodes and the presence of distal metastasis. [55]

Stages of Prostate Cancer
Stages of Prostate Cancer

Stage I: Cancer cannot be felt during a DRE, but it may be found during surgery being done for another reason. Cancer has not yet spread to other areas.

Stage II: Cancer can be felt during a DRE or discovered during a biopsy. Cancer has not yet spread.

Stage III: Cancer has spread to nearby tissue. 

Stage IV: Cancer has spread to lymph nodes or to other parts of the body. 

Differential Diagnosis

Differential diagnosis include a number of conditions that may share common signs and symptoms with PCa.

  • Obstruction of the lower urinary tract
  • Cancer of the bladder
  • Hemorrhage, cysts, calcifications, atrophy and fibrosis of the prostate
  • Prostatitis (acute or chronic)
  • Granulomatous prostatitis containing tuberculosis
  • Prostatic abscess
  • Benign prostatic hyperplasia (BPH)
  • Exophytic benign prostatic hyperplasia
  • Musculoskeletal pain: Low back, hip, or leg pain
  • Bony metastases of PCa are often blastic(i.e. demonstrate an increased bone density on radiologic imaging), they can cause lytic lesions which may mimic Paget's disease.
  • Any sudden neurologic changes of the lower extremities such as weakness in older men with a history of PCa may raise awareness of possible spinal cord compression.

[62][63][64][65]

Core Outcome Sets

Core sets of outcomes have been proposed for PCa in Europe. These Core Outcome Sets (COSs) have been developed for localised, locally Advanced, metastatic, and non-metastatic castration-resistant PCa following the PIONEER research project and they are work in progress. [66] For more information, you can visit the Core Outcome Sets - PIONEER page.

You can also watch the following video providing further explanations on this topic.

[67]

Medical Management

Medical management in PCa aims to prevent cancer progress and increase patient's life expectancy, address symptoms and side-effects from treatment, and improve quality of life for the patient. This may involve various strategies that should be tailored to the patient's condition and status, needs and preferences.

The first step in PCa management is determining whether any treatment is needed at all - in other words, if there is any curative intent or not. [68] This strategy is intended to restrict overdiagnosis and overtreatment in the clinical care pathway. Two factors are commonly considered in clinical decision-making:

  1. Evaluation of life expectancy
  2. Patient health status

[34]

Evaluation of Life Expectancy

Evaluation of life expectancy must follow an individualised approach, incorporating age and predictive estimates such as gait speed. [53] [69] Nevertheless, life expectancy tables are available through statistics platforms (e.g. Eurostat for the European region). [70]

Consideration of Associated Co-Morbidities

PCa may be associated with several comorbid conditions that already exist or may develop alongside the cancer and influence health status. Such examples are:

  • chronic pain
  • osteoporosis
  • hypertension
  • hyperlipidaemia
  • connective tissue disease or arthritis
  • diabetes
  • COPD
  • urinary issues
  • sexual dysfunction
  • problems with vision, or another organ.
  • psychological problems

[71] [72]

Clinically relevant comorbidities should be included and addressed in the overall treatment plan as they may alter the risk of advanced disease, treatment decisions, quality of life, morbidity and mortality. [73] Despite the fact that age of a patient is a stronger predictor of treatment choices than comorbidities, comorbidities may have a greater impact on mortality.[74] For example, a study on 15,695 South Australian men diagnosed with PCa who presented with ≥3 comorbid conditions, especially when these involved cardiac disease, chronic airway disease, depression/anxiety, and thrombosis predicted a poor prostate cancer-specific survival. [75]

Medical Management Strategies

The selection of medical management for a patient with PCa depends on a variety of factors that reflect the expected outcome of the intervention(s). Predictive tools have been developed to guide individualised strategies for newly diagnosed patients with PCa in the early stages; such an example is the Predict Prostate prognostic model where the benefits of active vs. conservative treatment and death are weighed and estimated. [76]

Following consideration of all relevant information for PCa, management options can be as follows:

Watchful Waiting

Watchful waiting (WW) is a monitoring strategy on patients who are neither candidates for curative treatment nor for palliative therapy in the early stages of management. [77] The aim is to watch for the development of local or systemic progression of the disease, at which stage disease-related symptoms are then treated palliatively to maintain quality of life (QoL). [53]

Active Surveillance

Many low-risk cases are followed over time. Under active surveillance (AS), patients are usually required to have regular, periodic PSA testing and at least one additional biopsy 12 to 18 months after the original diagnosis. [6] It is expected that the delay in unecessary local curative interventions because of the initial expectant management strategy does not result in any unfavourable outcomes. [53] In a review of 22 studies of interventions that could be of benefit during AS, 5-alpha reductase inhibitors (5-ARIs) were found to be correlated with improved progression-free survival and minimal toxicity, whereas vitamin D3, chlormadinone, fexapotide triflutate (FT), and enzalutamide were somewhat efficacious, but demonstrated treatment-related adverse events in up to 88% of patients. [78]

Active Treatment

This is usually the case for patients with intermediate- or high-risk PCa and longest expected survival or advanced disease. Interprofessional teams are responsible for the treatment of these patients through communication and coordination of care. Various health professionals e.g. primary care providers, urologists, oncologists, radiation oncologists, and allied health professions may provide diagnoses and care plans. Through integrated care planning, [79] the interprofessional team can optimise outcomes for patients with PCa.

Medical Management in Localised versus Advanced PCa

In localised disease, therapy is usually offered to those patients who are reasonably expected to live another ten years or longer based on age and health status. [34] This is because it has been found that older low-risk PCa patients with worse baseline health status will experience smaller benefits from surgery vs. active surveillance, [80] or where superiority of surgery versus active surveillance has been indicated, this superiority is evident after ten years [81] or complications (e.g. urinary incontinence and erectile dysfunction) after the prostatectomy were observed. [82] However, this may concern life-expectancy and not risk of metastases and use of androgen deprivation therapy (ADT) in men of increased age. [83] Nevertheless, the authors conclude that patient preferences affect treatment outcomes, should be a priority in shared decision making and optimal management, [80] and therefore, discussions should focus on balancing the goals of therapy (possible cancer cure, the potential for increased survival, psychologically "getting rid" of the cancer) with the risks of lifestyle alterations (treatment side effects, complications, cost, possible lack of ultimate survival benefit and questionable quality of life improvement over doing nothing). [84]

Treatment of localised disease may include radiation therapy (external beam and/or brachytherapy radioactive seed placement), radical prostatectomy and cryotherapy (usually reserved for radiation therapy failures). Radiation therapy tends to have much fewer side effects (such as erectile dysfunction and urinary incontinence) than radical prostatectomy surgery with similar (but not superior) overall long-term survival for low- to intermediate-risk patient. [85]

Medical management in advanced / metastatic PCa aims to control the disease progress and metastasis to further sites, manage symptoms (e.g. relieving bone pain via pain medication), and improve the patients' quality of life. Again, because there is a risk of undertreatment for men of older age or younger men with intermediate- and high-risk localised disease, care should be taken to prevent PCa in its earlier stages. [86] [87]

Management of these patients may include treatments such as hormone therapy, chemotherapy, radiation therapy, immunotherapy, surgery or a combination of modalities. The field of treatment for advanced PCa is evolving and in view of advances in molecular research and new drug development, new approaches are emerging. [88]

Treatment Modalities

Radical Prostatectomy
Radical Prostatectomy

Prostatectomy 

This involves the removal of the prostate gland with the aim to eradicate cancer. A radical prostatectomy is the removal of the prostate gland with its capsule intact, and some surrounding tissue followed by vesico-urethral anastomosis. [53]Surgical procedures involving prostatectomy have evolved tremendously since their introduction in PCa treatment, and minimally invasive robot-assisted techniques have been in practice since 2000. [89] Developments in surgical procedures have increased its use as a first-line treatment as a part of a multimodal approach in advanced local and early metastatic PCa cases. [89]

Radiation Therapy (RT) 

Radiation therapy (RT) refers to the use of high-energy radiation to try to kill the cancer cells. There two common types of RT: in external beam radiation therapy, the radiation is directed into the cancer cells from the outside of the body (this is the standard treatment); in brachytherapy (internal radiation therapy, radioactive pellets are surgically implanted into the cancerous area to try to kill the cells from the inside of the body. [53]

The European Association of Urology proposes the use of clinical tumor characteristics when deciding for adjuvant radiation therapy after radical prostatectomy in high-risk prostate cancer patients; as a result refinements to this model have been recently studied using a multivariable model to predict pre-operative decisions for RT after radical prostatectomy but these require external validation to be applied to clinical decisions. [90]

High-Intensity Focused Ultrasound (HIFU)

High intensity focused ultrasound (HIFU) uses focused sound waves emitted from a transducer to destroy malignant tissue by mechanical, thermal effects and cavitation. HIFU is performed under general or spinal anaesthesia, with the patient lying in the lateral or supine position. Access to the area of interest is made through transrectally or transurithrally, and in some cases there is a magnetic resonance imaging (MRI) fusion option with real-time monitoring allowing for better precision in ablation. In large prostates, access of probe from the rectum for HIFU delivery may present with some challenges. [91][92]

Cryotherapy

Cryotherapy is also known as cryoablation or cryosurgery. This minimally invasive procedure includes placing a probe near the cancer cells to try to kill them by freezing them. Cryosurgery can involve parts or the whole of the prostate gland. [93] It is performed under anesthesia and uses transrectal ultrasound is used to guide the probes. This procedure is offered as an alternative to surgery for patients that are not suitable candidates for radical prostatectomy. [94] Although sound outcome data are lacking, supporters report improved preservation of surrounding tissue and faster recovery rates. [94] [93]

Systemic Treatment /Medications

There are many medications that can be used in the treatment of PCa. Pharmacotherapy is used in isolation or in combination in hopes to induce remission, reduce morbidity and reduce complications. [63] Some of the more common medication categories used for PCa include the following options.

Hormone Therapy

Hormone therapy is also called androgen deprivation therapy (ADT). [95] PCa is a highly androgen-dependent disease; therefore, it is postulated that cancer cells should be blocked from obtaining the male hormones needed to grow. [95]There are various types of ADT.

Luteinizing Hormone Releasing Hormone (LHRH) Agonists: injections that lower testosterone production e.g. leuprolide , goserelin, triptorelin [96]

Luteinizing Hormone Releasing Hormone (LHRH) Antagonists: for a more direct blockage of testosterone production and flares e.g., degarelix, relugolix (oral form) [97]

Androgen Synthesis Inhibitors: stop the production of male hormones by blocking an enzyme called CYP17, which the body needs to make testosterone e.g. abiraterone acetate, ketoconazole [98]

Antiandrogens: prevent testosterone from binding to the cancer cells e.g. enzalutamide, apalutamide, bicalutamide [99]

Bisphosphonates

This therapeutic option is used in men with advanced PCa and with bone metastases e.g. zoledronic acid (injection). The mechanism of action involves slowing down the activity of osteclasts to prevent osteoporosis. [100]

Antifungal Agents

Antifungal agents (e.g. ketoconazole, liarozole) can work similar to antiandrogens in high doses; they are used when antiandrogens fail. [101]

Chemotherapeutic Agents

Chemotherapy involves the use of drugs (oral or intravenous) to try to kill or reduce in size the cancer cells. It is indicated for cases of hormone refractory, locally advanced, high risk of metastasis PCa. [102][103][104] Drugs such as docetaxel, cabazitaxel (second generation taxane) are shown to improve overall survival for men with metastatic castration-resistant PCa. [105]

Radiopharmaceuticals

Radiopharmaceuticals include radioactive agents e.g. Lutetium-177-PSMA-617, Radium-223 that are IV delivered to target radiation to cancer cells. [106] PSMA-targeted therapy in the form of injectable targeted radiation has been recently approved by the Food and Drug Administration (FDA) to treat patients with metastatic prostate cancer with limited success with other therapeutic options because of its promising potential.[107] [108] Furthermore, a recent review on Radium-223 in men with metastatic cancer showed survival benefits, a favorable safety profile, and low rates of fracture when Ra-223 is used early, in five or more cycles, with guideline-recommended bone health agents (BHAs). [109]

Corticosteroids

Antinflammatory action of corticosteroids is used in combination with active agents such as docetaxel, cabazitaxel and abiraterone to counteract their effects or to relieve from pain and inflammation from bone spread, reduce fatigue etc. However, care must be taken when used chronically, especially in steroid-induced adrenal insufficiency due to their numerous side-effects. Examples of corticosteroids used in PCa are Prednisone, Hydrocortisone, Dexamethasone. [110][111]

Immunotherapy 

Immunotherapy refers to cancer vaccines made specifically for each man that works to boost the body’s immune system to kill PCa cells. [112] The most widely used immunotherapy is the Sipuleucel-T injection for advanced castrate-resistant PCa. [113] Immunotherapy is not yet considered standard treatment because of the observed complexity and heterogeneity of interactions between the immune system and PCa. [114] Vaccine therapy is mainly used for advanced cancers that are not responding to hormone therapy, however, there is an emerging research field that also targets early stage PCa. [115]

Physiotherapy Management

Physiotherapy can be offered before and after treatment for PCa to minimise its impact and toll on patients; clinicians are required to work with the interprofessional team, educate the patient with PCa, discuss questions and offer practical advice and strategies to help the patient in the various stages of the treatment.[116] For a detailed coverage on Physiotherapy assessment and management for patients with PCa you can visit the following pages:

Physiotherapy Assessment After Prostate Cancer

Physiotherapy Treatment After Prostate Cancer

Guidelines and the Future of PCa Management

There a number of national and international guidelines published for the management of PCa that you can find in the Clinical Guidelines: Oncology page. Sixteen have been assessed and most have been found to be a useful reference of high quality for clinicians; reasons for lower quality scores were mostly methodological and due to low patient engagement. [117] Consistency of recommendations is another factor that was brought to the table as an important issue because of observed global variations in PCa management.[117]

According to a 2025 policy report from the Global Action on Men's Health, PCa is currently not sufficiently addressed in global and national cancer policies. [118] As a result an invitation has been made for a coordinated global response and focused action to address men's specific needs, especially those who currently experience poorer health outcomes. [118]A 10-point action plan has been proposed covering:

  1. Coverage in national and international policies
  2. Improvement in national and global data collection
  3. Education and awareness on prostate health and cancer
  4. Early diagnosis through national screening programmes
  5. Quick and free/affordable access to effective care
  6. Greater investment in PCa research
  7. More focus on high-risk groups
  8. Greater and specific role of Non-Governmental Organisations in PCa services
  9. Appropriate training of health professionals according to national and international guidance
  10. Higher funding for PCa

[118]

The Use of Artificial Intelligence in PCa

While technological advancements continue to expand to all sectors of life, Artificial Intelligence (AI), has emerged as a promising technology in healthcare and cancer care in particular. According to a recent systematic review, [119] the current landscape of AI tools in PCa care shows that AI science is developing in various areas, with medical image analysis and detection of PCa being one of the most prominent areas of application. [120] However, widespread adoption in clinical practice due to practical and ethical reasons is still missing. [119]

The Prostate Cancer Diagnosis and Treatment Enhancement Through the Power of Big Data in Europe (PIONEER) project refers to a European network that aims to utilise the potential of big data in PCa, involving 9 countries across Europe. [121] So far, the project has identified key areas for PCa research [122] and is working on standardising and assembling PCa research data - despite challenges of real-world data in terms of availability and suitability - into a single platform. [123] Lately, UroEvidenceHub of the European Association of Urology has joined forces with the PIONEER project for the improvement of PCa data for big data use. [123]

The Optimal Treatment for Patients with Solid Tumours in Europe Through Artificial intelligence (OPTIMA) project is another ambitious research work that is envisaged to bring the latest individualised treatments and innovative therapies for cancer groups including PCa patients. [124] OPTIMA aims to tackle practical and ethical challenges by delivering the first interoperable, GDPR-compliant central oncology database and platform in Europe. [125]

Case Reports/ Case Studies

1. Glode LM. Case Reports on Prostate Cancer. Reviews in Urology 2004;6(Suppl 7):S39-45.

2. Kubicka-Wolkowska J, Debska-Szmich S, Lisik-Habib M, Noweta M, Potemski P. Malignant acanthosis nigricans associated with prostate cancer: a case report. BMC Urology. 2014;14:88.

3. Bourlon M, Glode L, Crawford E. Base of the Skull Metastases in Metastatic Castration-Resistant Prostate Cancer. Oncology (Williston Park). 2014 Dec;28(12):1115-6, 1124.

4. Aksoy S, Orhan K, Kursun S, Eray Kolsuz M, Celikten B. Metastasis of prostate carcinoma in the mandible manifesting as numb chin syndrome. World J Surg Oncol. 2014;12:401.

5. Taheri H, Ebrahimi P, Nazari P, Kefayat A, Mahdavian A. An unusual presentation of metastatic prostate cancer in a 44-year-old man: A case report and review of the literature. Clin Case Rep. 2024 Jan 28;12(2):e8447.

6. Hsu JY, Lin YS, Huang LH, Wen WC, Gao HW, Hsu CY, Ou YC, Tung MC. A case report on the atypical metastatic pathway of prostate cancer to the kidney and stomach. Urol Case Rep. 2024 Aug 3;56:102816.

7. Zhang Z, Xu M, Shang M, Liu Z, Yang L, Yu D. Case report: Malignant priapism: penile metastasis from prostate cancer with low serum PSA level. Front Oncol. 2025 Jan 10;14:1395301.

8. Gopishetty S, Singh L, Aqil M, Elhalis A, Ezekwudo D. Prostate Cancer With Orbital Metastasis. Cureus. 2025 Mar 17;17(3):e80727.

Resources

American Cancer Society (www.cancer.org)

Prostate Cancer Foundation (formerly CaPCURE) (www.pcf.org)

US Too International, Inc. (www.ustoo.com)

Urology Care Foundation (www.urologyhealth.org)

National Association for Continence (www.nafc.org)

National Cancer Institute (www.cancer.gov)

National Coalition for Cancer Survivorship (www.canceradvocacy.org)

Zero Prostate Cancer (https://zerocancer.org/)

To get more information, visit the National Cancer Institute’s (NCI’s) Prostate Cancer Treatment Option Overview, a site that can help to find a healthcare provider or treatment site that cares for cancer. Also, go to Facing Forward: Life After Cancer Treatment for more information about treatment and can help help assist with various treatment sources.[126]

For statistics on PCa, you can visit the WHO Data Platform

For the latest news, research and resources on PCa, please visit the IARC on Prostate Cancer

Global Action on Men's Health: Prostate Cancer: Time for a New Global Initiative.

PIONEER project page - European Network of Excellence for Big Data on PCa

OPTIMA Project page.

References

  1. ↑ Toivanen R, Shen MM. Prostate organogenesis: tissue induction, hormonal regulation and cell type specification. Development. 2017 Apr 15;144(8):1382-1398.
  2. ↑ ICD10Data.com. 2025 ICD-10-CM Diagnosis Code C61. Available from: https://www.icd10data.com/ICD10CM/Codes/C00-D49/C60-C63/C61-/C61 [accessed 13/8/2025]
  3. ↑ Find-A-Code. 2C82 Malignant neoplasms of prostate. International Classification of Diseases for Mortality and Morbidity Statistics, 11th Revision, v2025-01. Available from: https://www.findacode.com/icd-11/code-1552457716.html#:~:text=ICD-11%20MMS%20code%202C82%20Malignant%20neoplasms%20of,prostate%20with%20excludes%2C%20code%20elsewhere%2C%20and%20included%20sections%2Fcodes. [accessed 26/9/2025]
  4. ↑ Daniyal M, Siddiqui ZA, Akram M, Asif HM, Sultana S, Khan A. Epidemiology, etiology, diagnosis and treatment of prostate cancer. Asian Pac J Cancer Prev. 2014;15(22):9575-8.
  5. ↑ Bashir MN. Epidemiology of Prostate Cancer. Asian Pac J Cancer Prev. 2015;16(13):5137-41.
  6. ↑ 6.0 6.1 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020 Jan;70(1):7-30.
  7. ↑ Europa UOMO. Prostate makes up 12% of all cancer cases in Europe. https://www.europa-uomo.org/news/prostate-makes-up-12-of-all-cancer-cases-in-europe/ [accessed 13/8/2025]
  8. ↑ Gandaglia G, Pellegrino F, Golozar A, De Meulder B, Abbott T, Achtman A, Imran Omar M, Alshammari T, Areia C, Asiimwe A, Beyer K, Bjartell A, Campi R, Cornford P, Falconer T, Feng Q, Gong M, Herrera R, Hughes N, Hulsen T, Kinnaird A, Lai LYH, Maresca G, Mottet N, Oja M, Prinsen P, Reich C, Remmers S, Roobol MJ, Sakalis V, Seager S, Smith EJ, Snijder R, Steinbeisser C, Thurin NH, Hijazy A, van Bochove K, Van den Bergh RCN, Van Hemelrijck M, Willemse PP, Williams AE, Zounemat Kermani N, Evans-Axelsson S, Briganti A, N'Dow J; PIONEER Consortium. Clinical Characterization of Patients Diagnosed with Prostate Cancer and Undergoing Conservative Management: A PIONEER Analysis Based on Big Data. Eur Urol. 2024 May;85(5):457-65.
  9. ↑ Schafer EJ, Laversanne M, Sung H, Soerjomataram I, Briganti A, Dahut W, Bray F, Jemal A. Recent Patterns and Trends in Global Prostate Cancer Incidence and Mortality: An Update. Eur Urol. 2025 Mar;87(3):302-3
  10. ↑ James ND, Tannock I, N'Dow J, Feng F, Gillessen S, Ali SA, Trujillo B, Al-Lazikani B, Attard G, Bray F, Compérat E, Eeles R, Fatiregun O, Grist E, Halabi S, Haran Á, Herchenhorn D, Hofman MS, Jalloh M, Loeb S, MacNair A, Mahal B, Mendes L, Moghul M, Moore C, Morgans A, Morris M, Murphy D, Murthy V, Nguyen PL, Padhani A, Parker C, Rush H, Sculpher M, Soule H, Sydes MR, Tilki D, Tunariu N, Villanti P, Xie LP. The Lancet Commission on prostate cancer: planning for the surge in cases. Lancet. 2024 Apr 27;403(10437):1683-1722.
  11. ↑ Lin J, Nousome D, Jiang J, Chesnut GT, Shriver CD, Zhu K. Five-year survival of patients with late-stage prostate cancer: comparison of the Military Health System and the U.S. general population. Br J Cancer. 2023 Apr;128(6):1070-1076.
  12. ↑ 12.0 12.1 American Cancer Society. Key Statistics for Prostate Cancer. Available from: https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html#:~:text=About%201%20in%208%20men,/ethnicity%2C%20and%20other%20factors. [accessed 12/8/2025]
  13. ↑ Gandaglia G, Karakiewicz PI, Briganti A, Passoni NM, Schiffmann J, Trudeau V, Graefen M, Montorsi F, Sun M. Impact of the Site of Metastases on Survival in Patients with Metastatic Prostate Cancer. Eur Urol. 2015 Aug;68(2):325-34.
  14. ↑ 14.0 14.1 Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023 Jan;73(1):17-48.
  15. ↑ Kelly SP, Anderson WF, Rosenberg PS, Cook MB. Past, Current, and Future Incidence Rates and Burden of Metastatic Prostate Cancer in the United States. Eur Urol Focus. 2018 Jan;4(1):121-7.
  16. ↑ Rowley KH, Mason MD. The aetiology and pathogenesis of prostate cancer. Clin Oncol (R Coll Radiol). 1997;9(4):213-8.
  17. ↑ Ng KL. The Etiology of Prostate Cancer. In: Bott SRJ, Ng KL, editors. Prostate Cancer [Internet]. Brisbane (AU): Exon Publications; 2021 May 27. Chapter 2. Available from: https://www.ncbi.nlm.nih.gov/books/NBK571322/+doi:+10.36255/exonpublications.prostatecancer.etiology.2021 [accessed 13/8/2025]
  18. ↑ Stangelberger A, Waldert M, Djavan B. Prostate cancer in elderly men. Rev Urol. 2008 Spring;10(2):111-9.
  19. ↑ Salinas CA, Tsodikov A, Ishak-Howard M, Cooney KA. Prostate cancer in young men: an important clinical entity. Nat Rev Urol. 2014 Jun;11(6):317-23.
  20. ↑ 20.0 20.1 Hinata N, Fujisawa M. Racial Differences in Prostate Cancer Characteristics and Cancer-Specific Mortality: An Overview. World J Mens Health. 2022 Apr;40(2):217-27.
  21. ↑ Cook LS, Goldoft M, Schwartz SM, Weiss NS. Incidence of adenocarcinoma of the prostate in Asian immigrants to the United States and their descendants. J Urol. 1999 Jan;161(1):152-5.
  22. ↑ Lillard JW Jr, Moses KA, Mahal BA, George DJ. Racial disparities in Black men with prostate cancer: A literature review. Cancer. 2022 Nov 1;128(21):3787-95.
  23. ↑ Haas GP, Delongchamps N, Brawley OW, Wang CY, de la Roza G. The worldwide epidemiology of prostate cancer: perspectives from autopsy studies. Can J Urol. 2008 Feb;15(1):3866-71.
  24. ↑ Barber L, Gerke T, Markt SC, Peisch SF, Wilson KM, Ahearn T, Giovannucci E, Parmigiani G, Mucci LA. Family History of Breast or Prostate Cancer and Prostate Cancer Risk. Clin Cancer Res. 2018 Dec 1;24(23):5910-5917.
  25. ↑ 25.0 25.1 25.2 25.3 Bergengren O, Pekala KR, Matsoukas K, Fainberg J, Mungovan SF, Bratt O, Bray F, Brawley O, Luckenbaugh AN, Mucci L, Morgan TM, Carlsson SV. 2022 Update on Prostate Cancer Epidemiology and Risk Factors-A Systematic Review. Eur Urol. 2023 Aug;84(2):191-206.
  26. ↑ Siltari A, Lönnerbro R, Pang K, Shiranov K, Asiimwe A, Evans-Axelsson S, Franks B, Kiran A, Murtola TJ, Schalken J, Steinbeisser C, Bjartell A, Auvinen A; PIONEER Consortium. How Well do Polygenic Risk Scores Identify Men at High Risk for Prostate Cancer? Systematic Review and Meta-Analysis. Clin Genitourin Cancer. 2023 Apr;21(2):316.e1-316.e11.
  27. ↑ Klein RJ, Vertosick E, Sjoberg D, Ulmert D, Rönn AC, Häggström C, Thysell E, Hallmans G, Dahlin A, Stattin P, Melander O, Vickers A, Lilja H. Prostate cancer polygenic risk score and prediction of lethal prostate cancer. NPJ Precis Oncol. 2022 Apr 8;6(1):25.
  28. ↑ Russo GI, Calogero AE, Condorelli RA, Scalia G, Morgia G, La Vignera S. Human papillomavirus and risk of prostate cancer: a systematic review and meta-analysis. Aging Male. 2020 Jun;23(2):132-8.
  29. ↑ Lian WQ, Luo F, Song XL, Lu YJ, Zhao SC. Gonorrhea and Prostate Cancer Incidence: An Updated Meta-Analysis of 21 Epidemiologic Studies. Med Sci Monit. 2015 Jul 1;21:1902-10.
  30. ↑ Brawer MK. Challenges with luteinizing hormone-releasing hormone agonists: flare and surge. Rev Urol. 2004;6 Suppl 7(Suppl 7):S12-8.
  31. ↑ 31.0 31.1 Ziglioli F, Patera A, Isgrò G, Campobasso D, Guarino G, Maestroni U. Impact of modifiable lifestyle risk factors for prostate cancer prevention: a review of the literature. Front Oncol. 2023 Sep 8;13:1203791.
  32. ↑ Gathirua-Mwangi WG, Zhang J. Dietary factors and risk for advanced prostate cancer. Eur J Cancer Prev. 2014 Mar;23(2):96-109.
  33. ↑ Oczkowski M, Dziendzikowska K, Pasternak-Winiarska A, Włodarek D, Gromadzka-Ostrowska J. Dietary Factors and Prostate Cancer Development, Progression, and Reduction. Nutrients. 2021 Feb 3;13(2):496.
  34. ↑ 34.0 34.1 34.2 Cornford P, van den Bergh RCN, Briers E, Van den Broeck T, Brunckhorst O, Darraugh J, Eberli D, De Meerleer G, De Santis M, Farolfi A, Gandaglia G, Gillessen S, Grivas N, Henry AM, Lardas M, van Leenders GJLH, Liew M, Linares Espinos E, Oldenburg J, van Oort IM, Oprea-Lager DE, Ploussard G, Roberts MJ, Rouvière O, Schoots IG, Schouten N, Smith EJ, Stranne J, Wiegel T, Willemse PM, Tilki D. EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer-2024 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2024 Aug;86(2):148-63.
  35. ↑ Rivera-Izquierdo M, Pérez de Rojas J, Martínez-Ruiz V, Pérez-Gómez B, Sánchez MJ, Khan KS, Jiménez-Moleón JJ. Obesity as a Risk Factor for Prostate Cancer Mortality: A Systematic Review and Dose-Response Meta-Analysis of 280,199 Patients. Cancers (Basel). 2021 Aug 19;13(16):4169.
  36. ↑ Ju-Kun S, Yuan DB, Rao HF, Chen TF, Luan BS, Xu XM, Jiang FN, Zhong WD, Zhu JG. Association Between Cd Exposure and Risk of Prostate Cancer: A PRISMA-Compliant Systematic Review and Meta-Analysis. Medicine (Baltimore). 2016 Feb;95(6):e2708.
  37. ↑ Islami F, Moreira DM, Boffetta P, Freedland SJ. A systematic review and meta-analysis of tobacco use and prostate cancer mortality and incidence in prospective cohort studies. Eur Urol. 2014 Dec;66(6):1054-64.
  38. ↑ Brookman-May SD, Campi R, Henríquez JDS, Klatte T, Langenhuijsen JF, Brausi M, Linares-Espinós E, Volpe A, Marszalek M, Akdogan B, Roll C, Stief CG, Rodriguez-Faba O, Minervini A. Latest Evidence on the Impact of Smoking, Sports, and Sexual Activity as Modifiable Lifestyle Risk Factors for Prostate Cancer Incidence, Recurrence, and Progression: A Systematic Review of the Literature by the European Association of Urology Section of Oncological Urology (ESOU). Eur Urol Focus. 2019 Sep;5(5):756-87.
  39. ↑ Zhang L, Wang Y, Qin Z, Gao X, Xing Q, Li R, Wang W, Song N, Zhang W. Correlation between Prostatitis, Benign Prostatic Hyperplasia and Prostate Cancer: A systematic review and Meta-analysis. J Cancer. 2020 Jan 1;11(1):177-189.
  40. ↑ Kakhki VR, Anvari K, Sadeghi R, Mahmoudian AS, Torabian-Kakhki M. Pattern and distribution of bone metastases in common malignant tumors. Nucl Med Rev Cent East Eur. 2013;16(2):66-9.
  41. ↑ Vinjamoori AH, Jagannathan JP, Shinagare AB, Taplin ME, Oh WK, Van den Abbeele AD, Ramaiya NH. Atypical metastases from prostate cancer: 10-year experience at a single institution. AJR Am J Roentgenol. 2012 Aug;199(2):367-72.
  42. ↑ Gosein M, Mohammed L, Chan A, Sinanan A, Banfield R, Maharaj P, Narinesingh D. A pictorial review of the less commonly encountered patterns of metastatic prostate carcinoma. Ecancermedicalscience. 2020 Dec 21;14:1159.
  43. ↑ 43.0 43.1 43.2 43.3 David MK, Leslie SW. Prostate-Specific Antigen. [Updated 2024 Sep 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557495/ [accessed 18/8/2025]
  44. ↑ 44.0 44.1 Sundaresan VM, Smani S, Rajwa P, Renzulli J, Sprenkle PC, Kim IY, Leapman MS. Prostate-specific antigen screening for prostate cancer: Diagnostic performance, clinical thresholds, and strategies for refinement. Urol Oncol. 2025 Jan;43(1):41-8.
  45. ↑ 45.0 45.1 American Cancer Society. American Cancer Society Recommendations for Prostate Cancer Early Detection. Available from: https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/acs-recommendations.html [accessed 18/8/2025]
  46. ↑ 46.0 46.1 U.S. Preventive Services Task Force. Prostate Cancer: Screening. An Update for This Topic is In Progress. https://www.uspreventiveservicestaskforce.org/uspstf/draft-update-summary/prostate-cancer-screening-adults [accessed 18/8/2025].
  47. ↑ Vaccarella S, Li M, Bray F, Kvale R, Serraino D, Lorenzoni V, Auvinen A, Dal Maso L. Prostate cancer incidence and mortality in Europe and implications for screening activities: population based study. BMJ. 2024 Sep 4;386:e077738.
  48. ↑ Castillejos-Molina RA, Gabilondo-Navarro FB. Prostate cancer. Salud Publica Mex. 2016 Apr;58(2):279-84.
  49. ↑ 49.0 49.1 Naji L, Randhawa H, Sohani Z, Dennis B, Lautenbach D, Kavanagh O, Bawor M, Banfield L, Profetto J. Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis. Ann Fam Med. 2018 Mar;16(2):149-54.
  50. ↑ Alotaibi KM. Incidence of prostate cancer among patients with prostate-related urinary symptoms: A single institution series in 10 years. Urol Ann. 2019 Apr-Jun;11(2):135-8.
  51. ↑ Centers for Disease Control and Prevention. Prostate Cancer. http://www.cdc.gov/cancer/prostate/index.htm (accessed 9 April 2016).
  52. ↑ CDC. Should I get tested for Prostate Cancer? Available from: https://www.youtube.com/watch?v=gUSLqrEiRl4 [accessed 18/8/2025]
  53. ↑ 53.0 53.1 53.2 53.3 53.4 53.5 53.6 53.7 European Association of Urology. EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer. Available from: https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-EANM-ESTRO-ESUR-ISUP-SIOG-Guidelines-on-Prostate-Cancer-2025_updated.pdf [accessed 21/8/2025]
  54. ↑ Descotes JL. Diagnosis of prostate cancer. Asian J Urol. 2019 Apr;6(2):129-136.
  55. ↑ 55.0 55.1 Jones R, Cornford p. EAU and NICE guidelines for the diagnosis and management of prostate cancer. How wide is the channel? J Clin Oncol 2018; 11(2): 149-53.
  56. ↑ 56.0 56.1 56.2 Munjal A, Leslie SW. Gleason Score. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553178/ [accessed 19/8/2025]
  57. ↑ Djavan B, Remzi M, Schulman CC, Marberger M, Zlotta AR. Repeat prostate biopsy: who, how and when?. a review. Eur Urol. 2002 Aug;42(2):93-103.
  58. ↑ Djavan B, Milani S, Remzi M. Prostate biopsy: who, how and when. An update. Can J Urol. 2005 Feb;12 Suppl 1:44-8; discussion 99-100.
  59. ↑ Serefoglu EC, Altinova S, Ugras NS, Akincioglu E, Asil E, Balbay MD. How reliable is 12-core prostate biopsy procedure in the detection of prostate cancer? Can Urol Assoc J. 2013 May-Jun;7(5-6):E293-8.
  60. ↑ 60.0 60.1 UICC. TNM Classification of Malignant Tumours. Available from: https://www.uicc.org/what-we-do/sharing-knowledge/tnm [accessed 3/9/2025]
  61. ↑ 61.0 61.1 D'Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, Tomaszewski JE, Renshaw AA, Kaplan I, Beard CJ, Wein A. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998 Sep 16;280(11):969-74.
  62. ↑ Han C, Zhu L, Liu X, Ma S, Liu Y, Wang X. Differential diagnosis of uncommon prostate diseases: combining mpMRI and clinical information. Insights Imaging. 2021 Jun 16;12(1):79.
  63. ↑ 63.0 63.1 Leslie SW, Soon-Sutton TL, Skelton WP. Prostate Cancer. [Updated 2024 Oct 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470550/ [accessed 20/8/2025]
  64. ↑ Smith SE, Murphey MD, Motamedi K, Mulligan ME, Resnik CS, Gannon FH. From the archives of the AFIP. Radiologic spectrum of Paget disease of bone and its complications with pathologic correlation. Radiographics. 2002 Sep-Oct;22(5):1191-216.
  65. ↑ Oh WJ, Chung AM, Kim JS, Han JH, Hong SH, Lee JY, Choi YJ. Differential Immunohistochemical Profiles for Distinguishing Prostate Carcinoma and Urothelial Carcinoma. J Pathol Transl Med. 2016 Sep;50(5):345-54.
  66. ↑ Beyer K, Moris L, Lardas M, Omar MI, Healey J, Tripathee S, Gandaglia G, Venderbos LDF, Vradi E, van den Broeck T, Willemse PP, Antunes-Lopes T, Pacheco-Figueiredo L, Monagas S, Esperto F, Flaherty S, Devecseri Z, Lam TBL, Williamson PR, Heer R, Smith EJ, Asiimwe A, Huber J, Roobol MJ, Zong J, Mason M, Cornford P, Mottet N, MacLennan SJ, N'Dow J, Briganti A, MacLennan S, Van Hemelrijck M; PIONEER Consortium. Updating and Integrating Core Outcome Sets for Localised, Locally Advanced, Metastatic, and Nonmetastatic Castration-resistant Prostate Cancer: An Update from the PIONEER Consortium. Eur Urol. 2022 May;81(5):503-14.
  67. ↑ PIONEER for Big Data in Prostate Cancer. Core Outcome Sets: What are they and why are they important. Available from: https://www.youtube.com/watch?v=6oA024N0xtE [accessed 25/9/2025]
  68. ↑ Mazhar D, Waxman J. Prostate cancer. Postgrad Med J. 2002 Oct;78(924):590-5.
  69. ↑ Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, Brach J, Chandler J, Cawthon P, Connor EB, Nevitt M, Visser M, Kritchevsky S, Badinelli S, Harris T, Newman AB, Cauley J, Ferrucci L, Guralnik J. Gait speed and survival in older adults. JAMA. 2011 Jan 5;305(1):50-8.
  70. ↑ Eurostat Data Browser. Life expectancy by age and sex. Available from: https://ec.europa.eu/eurostat/databrowser/view/demo_mlexpec/default/table?lang=en [accessed 23/8/2025]
  71. ↑ Ng HS, Koczwara B, Roder D, Vitry A. Development of comorbidities in men with prostate cancer treated with androgen deprivation therapy: an Australian population-based cohort study. Prostate Cancer Prostatic Dis. 2018 Sep;21(3):403-410.
  72. ↑ Benzo R, Moreno PI, Fox RS, Silvera CA, Walsh EA, Yanez B, Balise RR, Oswald LB, Penedo FJ. Comorbidity burden and health-related quality of life in men with advanced prostate cancer. Res Sq [Preprint]. 2023 Feb 16:rs.3.rs-2572781.
  73. ↑ Chamie K, Daskivich TJ, Kwan L, Labo J, Dash A, Greenfield S, Litwin MS. Comorbidities, treatment and ensuing survival in men with prostate cancer. J Gen Intern Med. 2012 May;27(5):492-9.
  74. ↑ Matthes KL, Limam M, Pestoni G, Held L, Korol D, Rohrmann S. Impact of comorbidities at diagnosis on prostate cancer treatment and survival. J Cancer Res Clin Oncol. 2018;144(4):707-15.
  75. ↑ Tiruye T, Roder D, FitzGerald LM, O'Callaghan M, Moretti K, Caughey GE, Beckmann K. Impact of comorbidities on prostate cancer-specific mortality: A population-based cohort study. Prostate. 2024 Sep;84(12):1138-45.
  76. ↑ Thurtle DR, Greenberg DC, Lee LS, Huang HH, Pharoah PD, Gnanapragasam VJ. Individual prognosis at diagnosis in nonmetastatic prostate cancer: Development and external validation of the PREDICT Prostate multivariable model. PLoS Med. 2019 Mar 12;16(3):e1002758.
  77. ↑ Coen JJ, Feldman AS, Smith MR, Zietman AL. Watchful waiting for localized prostate cancer in the PSA era: what have been the triggers for intervention? BJU Int. 2011 May;107(10):1582-6.
  78. ↑ Matsukawa A, Yanagisawa T, Bekku K, Parizi MK, Laukhtina E, Klemm J, Chiujdea S, Mori K, Kimura S, Miki J, Pradere B, Rivas JG, Gandaglia G, Kimura T, Kasivisvanathan V, Ploussard G, Cornford P, Shariat SF, Rajwa P. Nonsurgical Interventions to Prevent Disease Progression in Prostate Cancer Patients on Active Surveillance: A Systematic Review and Meta-analysis. Eur Urol Oncol. 2024 Jun;7(3):376-400.
  79. ↑ Khan AI, Arthurs E, Gradin S, MacKinnon M, Sussman J, Kukreti V. Integrated Care Planning for Cancer Patients: A Scoping Review. Int J Integr Care. 2017 Nov 13;17(6):5.
  80. ↑ 80.0 80.1 Liu D, Lehmann HP, Frick KD, Carter HB. Active surveillance versus surgery for low risk prostate cancer: a clinical decision analysis. J Urol. 2012 Apr;187(4):1241-6.
  81. ↑ Bill-Axelson A, Holmberg L, Garmo H, Taari K, Busch C, Nordling S, Häggman M, Andersson SO, Andrén O, Steineck G, Adami HO, Johansson JE. Radical Prostatectomy or Watchful Waiting in Prostate Cancer - 29-Year Follow-up. N Engl J Med. 2018 Dec 13;379(24):2319-29.
  82. ↑ Vernooij RW, Lancee M, Cleves A, Dahm P, Bangma CH, Aben KK. Radical prostatectomy versus deferred treatment for localised prostate cancer. Cochrane Database Syst Rev. 2020 Jun 4;6(6):CD006590.
  83. ↑ Bill-Axelson A, Holmberg L, Garmo H, Rider JR, Taari K, Busch C, Nordling S, Häggman M, Andersson SO, Spångberg A, Andrén O, Palmgren J, Steineck G, Adami HO, Johansson JE. Radical prostatectomy or watchful waiting in early prostate cancer. N Engl J Med. 2014 Mar 6;370(10):932-42.
  84. ↑ Hamdy FC, Donovan JL, Lane JA, Metcalfe C, Davis M, Turner EL, Martin RM, Young GJ, Walsh EI, Bryant RJ, Bollina P, Doble A, Doherty A, Gillatt D, Gnanapragasam V, Hughes O, Kockelbergh R, Kynaston H, Paul A, Paez E, Powell P, Rosario DJ, Rowe E, Mason M, Catto JWF, Peters TJ, Oxley J, Williams NJ, Staffurth J, Neal DE; ProtecT Study Group. Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. N Engl J Med. 2023 Apr 27;388(17):1547-1558.
  85. ↑ Chen L, Li Q, Wang Y, Zhang Y, Ma X. Comparison on efficacy of radical prostatectomy versus external beam radiotherapy for the treatment of localized prostate cancer. Oncotarget. 2017 Aug 9;8(45):79854-79863.
  86. ↑ Hamilton AS, Albertsen PC, Johnson TK, Hoffman R, Morrell D, Deapen D, Penson DF. Trends in the treatment of localized prostate cancer using supplemented cancer registry data. BJU Int. 2011 Feb;107(4):576-84.
  87. ↑ Scosyrev E, Messing EM, Mohile S, Golijanin D, Wu G. Prostate cancer in the elderly: frequency of advanced disease at presentation and disease-specific mortality. Cancer. 2012 Jun 15;118(12):3062-70.
  88. ↑ González Del Alba A, Méndez-Vidal MJ, Vazquez S, Castro E, Climent MA, Gallardo E, Gonzalez-Billalabeitia E, Lorente D, Maroto JP, Arranz JA. SEOM clinical guidelines for the treatment of advanced prostate cancer (2020). Clin Transl Oncol. 2021 May;23(5):969-979.
  89. ↑ 89.0 89.1 Costello AJ. Considering the role of radical prostatectomy in 21st century prostate cancer care. Nat Rev Urol. 2020 Mar;17(3):177-188.
  90. ↑ Siech C, von Kriegstein H, Wenzel M, Cano Garcia C, Le QC, Tennstedt P, Preisser F, Maurer T, Kriegmair M, Chun FKH, Graefen M, Tilki D, Mandel P. Predicting the indication for adjuvant radiation therapy according to EAU guidelines among patients with high-risk prostate cancer: a novel multivariable model. Prostate Cancer Prostatic Dis. 2025 Sep 3.
  91. ↑ Madersbacher S, Marberger M. High-energy shockwaves and extracorporeal high-intensity focused ultrasound. J Endourol. 2003 Oct;17(8):667-72.
  92. ↑ Wu X, Wu Y, Ng CF, Yee CH, Chiu PK. High-intensity focused ultrasound strategies for treating prostate cancer. Asian J Androl. 2024 Nov 1;26(6):595-599.
  93. ↑ 93.0 93.1 Jung JH, Risk MC, Goldfarb R, Reddy B, Coles B, Dahm P. Primary cryotherapy for localised or locally advanced prostate cancer. Cochrane Database Syst Rev. 2018 May 30;5(5):CD005010.
  94. ↑ 94.0 94.1 Chin YF, Lynn N. Systematic Review of Focal and Salvage Cryotherapy for Prostate Cancer. Cureus. 2022 Jun 28;14(6):e26400.
  95. ↑ 95.0 95.1 Desai K, McManus JM, Sharifi N. Hormonal Therapy for Prostate Cancer. Endocr Rev. 2021 May 25;42(3):354-73.
  96. ↑ de Jong IJ, Eaton A, Bladou F. LHRH agonists in prostate cancer: frequency of treatment, serum testosterone measurement and castrate level: consensus opinion from a roundtable discussion. Curr Med Res Opin. 2007 May;23(5):1077-80.
  97. ↑ Crawford ED, Hou AH. The role of LHRH antagonists in the treatment of prostate cancer. Oncology (Williston Park). 2009 Jun;23(7):626-30.
  98. ↑ Stein MN, Patel N, Bershadskiy A, Sokoloff A, Singer EA. Androgen synthesis inhibitors in the treatment of castration-resistant prostate cancer. Asian J Androl. 2014 May-Jun;16(3):387-400.
  99. ↑ Reid P, Kantoff P, Oh W. Antiandrogens in prostate cancer. Invest New Drugs. 1999;17(3):271-84.
  100. ↑ Nayyar R, Gupta NP. Use of bisphosphonates in prostate cancer: Current status. Indian J Urol. 2007 Jan;23(1):51-4.
  101. ↑ Mahler C, Verhelst J, Denis L. Ketoconazole and liarozole in the treatment of advanced prostatic cancer. Cancer. 1993 Feb 1;71(3 Suppl):1068-73.
  102. ↑ Narayan S, Smith DC, Sandler HM. Chemotherapy for localized, high-risk prostate cancer. Semin Radiat Oncol. 2003 Apr;13(2):152-7.
  103. ↑ Aragon-Ching JB. Adjuvant Chemotherapy for High-Risk Localized Prostate Cancer: Time for Change or Need More Time to Change? J Clin Oncol. 2019 Sep 1;37(25):2296-7.
  104. ↑ McKay RR, Feng FY, Wang AY, Wallis CJD, Moses KA. Recent Advances in the Management of High-Risk Localized Prostate Cancer: Local Therapy, Systemic Therapy, and Biomarkers to Guide Treatment Decisions. Am Soc Clin Oncol Educ Book. 2020 May;40:1-12.
  105. ↑ Baciarello G, Delva R, Gravis G, Tazi Y, Beuzeboc P, Gross-Goupil M, Bompas E, Joly F, Greilsamer C, Hon TNT, Barthelemy P, Culine S, Berdah JF, Deblock M, Ratta R, Flechon A, Cheneau C, Maillard A, Martineau G, Borget I, Fizazi K; Groupe d’Etude des Tumeurs Uro-Genitales (GETUG).. Patient Preference Between Cabazitaxel and Docetaxel for First-line Chemotherapy in Metastatic Castration-resistant Prostate Cancer: The CABADOC Trial. Eur Urol. 2022 Mar;81(3):234-40.
  106. ↑ Civan C, Guberina N, Krafft U, Fendler WP, Stuschke M, Herrmann K. Radiopharmaceuticals in Prostate Cancer: General Considerations and Utility in Combination With EBRT. Semin Radiat Oncol. 2025 Jul;35(3):463-473.
  107. ↑ Hennrich U, Eder M. [177Lu]Lu-PSMA-617 (PluvictoTM): The First FDA-Approved Radiotherapeutical for Treatment of Prostate Cancer. Pharmaceuticals (Basel). 2022 Oct 20;15(10):1292.
  108. ↑ Charron J, Maupin K, Su C, Mancini B, Kulkarni H. Evaluating the Efficacy and Safety of Pluvicto in Chemotherapy-Ineligible Nonagenarians: A Descriptive Case Series. Cureus. 2025 Feb 16;17(2):e79119.
  109. ↑ Lunan-Taylor M, Raval AD, Nhan Phan NT, Korn MJ, Quintero V, McKay RR. Radium-223 in Men with Metastatic Castration-resistant Prostate Cancer: A Systematic Literature Review of Real-world Outcomes in Observational Studies. Eur Urol Oncol. 2025 Aug;8(4):1150-1164.
  110. ↑ Sideris S, Aoun F, Martinez CN, Latifyan S, Awada A, Costante G, Gil T. Role of corticosteroids in prostate cancer progression: implications for treatment strategy in metastatic castration-resistant patients. J Endocrinol Invest. 2016 Jul;39(7):729-38.
  111. ↑ De Santis M, Saad F. Practical Guidance on the Role of Corticosteroids in the Treatment of Metastatic Castration-resistant Prostate Cancer. Urology. 2016 Oct;96:156-64.
  112. ↑ Mitsogiannis I, Tzelves L, Dellis A, Issa H, Papatsoris A, Moussa M. Prostate cancer immunotherapy. Expert Opin Biol Ther. 2022 May;22(5):577-590.
  113. ↑ Thara E, Dorff TB, Averia-Suboc M, Luther M, Reed ME, Pinski JK, Quinn DI. Immune response to sipuleucel-T in prostate cancer. Cancers (Basel). 2012 Apr 18;4(2):420-41.
  114. ↑ Zhou W, Lu X, Tian F, Luo Q, Zhou W, Yang S, Li W, Yang Y, Shi M, Zhou T. Vaccine Therapies for Prostate Cancer: Current Status and Future Outlook. Vaccines (Basel). 2024 Dec 9;12(12):1384.
  115. ↑ Abdul Sater H, Marté JL, Donahue RN, Walter-Rodriguez B, Heery CR, Steinberg SM, Cordes LM, Chun G, Karzai F, Bilusic M, Harmon SA, Turkbey IB, Choyke PL, Schlom J, Dahut WL, Madan RA, Pinto PA, Gulley JL. Neoadjuvant PROSTVAC prior to radical prostatectomy enhances T-cell infiltration into the tumor immune microenvironment in men with prostate cancer. J Immunother Cancer. 2020 Mar;8(1):e000655.
  116. ↑ Bernardo-Filho M, Barbosa Júnior ML, da Cunha Sá-Caputo D, de Aguiar Ede O, de Lima RP, Santos-Filho SD, de Paoli S, Presta GA, de Oliveira Bravo Monteiro M, Tavares A. The relevance of the procedures related to the physiotherapy in the interventions in patients with prostate cancer: short review with practice approach. Int J Biomed Sci. 2014 Jun;10(2):73-84.
  117. ↑ 117.0 117.1 Sakalis V, Bhattacharya Y, Beyer K, Murray C, Smith EJ, Willemse PM, Gandaglia G, Boissier R, Borkowetz A, Dabestani S, Leenen RCA, Vilaseca A, Maresca G, Teoh J, Gómez Rivas J, Rajwa P, Lardas M, Grivas N, Van den Broeck T, Pradere B, Schouten N, Tandogdu Z, Evans-Axelsson S, Maclennan S, Thomas M, Briganti A, Bjartell A, Cornford P, Kruger H, N'Dow J, Roobol MJ, Omar MI; OPTIMA Consortium. AGREE II Quality Assessment of National and International Clinical Practice Guidelines on Prostate Cancer Management by the OPTIMA Consortium. Eur Urol Open Sci. 2024 Nov 12;70:183-193.
  118. ↑ 118.0 118.1 118.2 Global Action on Men's Health. Prostate Cancer: A new global initiative. Available from: https://gamh.org/wp-content/uploads/2025/06/prostate_cancer_2025_12pp-FINALwebpdf.pdf [accessed 4/9/2025]
  119. ↑ 119.0 119.1 Agrawal S, Vagha S. A Comprehensive Review of Artificial Intelligence in Prostate Cancer Care: State-of-the-Art Diagnostic Tools and Future Outlook. Cureus. 2024 Aug 5;16(8):e66225.
  120. ↑ Alowais SA, Alghamdi SS, Alsuhebany N, Alqahtani T, Alshaya AI, Almohareb SN, Aldairem A, Alrashed M, Bin Saleh K, Badreldin HA, Al Yami MS, Al Harbi S, Albekairy AM. Revolutionizing healthcare: the role of artificial intelligence in clinical practice. BMC Med Educ. 2023 Sep 22;23(1):689.
  121. ↑ Omar MI, Roobol MJ, Ribal MJ, Abbott T, Agapow PM, Araujo S, Asiimwe A, Auffray C, Balaur I, Beyer K, Bernini C, Bjartell A, Briganti A, Butler-Ransohoff JE, Campi R, Cavelaars M, De Meulder B, Devecseri Z, Voss MD, Dimitropoulos K, Evans-Axelsson S, Franks B, Fullwood L, Horgan D, Smith EJ, Kiran A, Kivinummi K, Lambrecht M, Lancet D, Lindgren P, MacLennan S, MacLennan S, Nogueira MM, Moen F, Moinat M, Papineni K, Reich C, Reiche K, Rogiers S, Sartini C, van Bochove K, van Diggelen F, Van Hemelrijck M, Van Poppel H, Zong J, N'Dow J; PIONEER Consortium. Introducing PIONEER: a project to harness big data in prostate cancer research. Nat Rev Urol. 2020 Jun;17(6):351-62.
  122. ↑ Omar MI, MacLennan S, Ribal MJ, Roobol MJ, Dimitropoulos K, van den Broeck T, MacLennan SJ, Axelsson SE, Gandaglia G, Willemse PP, Mastris K, Ransohoff JB, Devecseri Z, Abbott T, De Meulder B, Bjartell A, Asiimwe A, N'Dow J; PIONEER Consortium. Unanswered questions in prostate cancer - findings of an international multi-stakeholder consensus by the PIONEER consortium. Nat Rev Urol. 2023 Aug;20(8):494-501.
  123. ↑ 123.0 123.1 Lawlor A, Beyer K, Russell B, Steinbeisser C, Bjartell A, De Meulder B, Omar MI, Hulsen T, Butler J, N'Dow J, Rivas JG, Gandaglia G, Nicoletti R, Sakalis V, Smith EJ, Maass M, Zong J, Fullwood L, Abbott T, Tafreshiha A, Papineni K, Snijder R, Horgan D, Seager S, Evans-Axelsson S, Ribal MJ, Roobol MJ, Van Hemelrijck M; PIONEER Consortium. PIONEER big data platform for prostate cancer: lessons for advancing future real-world evidence research. Nat Rev Urol. 2025 Feb;22(2):116-24.
  124. ↑ N'Dow J, Smith EJ, Sarah C, Powell PA, Williams C, Speirs V et al. OPTIMA: new research project aims to improve treatment for patients with prostate, breast and lung cancer through artificial intelligence. Abstract from Annual EAU Conference 2024, Milan, Italy. Available from: https://abdn.elsevierpure.com/en/publications/optima-new-research-project-aims-to-improve-treatment-for-patient [accessed 27/8/2025]
  125. ↑ OPTIMA. Tackling cancer through real world data and artificial intelligence. Available from: https://www.optima-oncology.eu [accessed 4/9/2025]
  126. ↑ American Cancer Society. Prostate Cancer. http://www.cancer.org/cancer/prostatecancer/index (accessed 9 April 2016).
Retrieved from "https://www.physio-pedia.com/w/index.php?title=Prostate_Cancer&oldid=372399"