Worldwide, prostate cancer is the most commonly diagnosed malignancy and the sixth leading cause of cancer death in men. Diagnosis is primarily based on prostate-specific antigen (PSA) testing, MRI scans, and prostate tissue biopsies, although PSA testing for screening remains controversial. New diagnostic technologies including risk stratification bioassay tests, germline testing, and various PET scans are now available. When the cancer is limited to the prostate, it is considered localized and potentially curable. If the disease has spread outside the prostate, bisphosphonates, rank ligand inhibitors, hormonal treatment, chemotherapy, radiopharmaceuticals, immunotherapy, focused radiation, and other targeted therapies can be used. This activity is a current, comprehensive review of the evaluation and management of patients with prostate cancer and highlights the role of the interprofessional team in improving care for affected patients.

Objectives:

Worldwide, prostate cancer is the most commonly diagnosed male malignancy and the fifth leading cause of cancer death in men.[1][2] This amounted to 1,414,249 newly diagnosed cases and 375,000 deaths worldwide yearly from this disease in 2020.[1][2][3][4][5] Globally, prostate cancer is the most commonly diagnosed malignancy in more than fifty percent of countries (112 of 185).[6]

Fortunately, most prostate cancers tend to grow slowly and are low-grade with relatively low risk and limited aggressiveness.[7]

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.[8][9]

Newer diagnostic modalities include free and total PSA levels, PCA3 urine testing, Prostate Health Index scoring (PHI), the"4K" test, exosome testing, genomic analysis, MRI imaging, PIRADS scoring, and MRI-TRUS fusion guided biopsies.[10] 

When the cancer is limited to the prostate, it is considered localized and potentially curable.[11]

If the disease has spread to the bones or elsewhere outside the prostate, pain medications, bisphosphonates, rank ligand inhibitors, hormonal treatment, chemotherapy, radiopharmaceuticals, immunotherapy, focused radiation, and other targeted therapies can be used. Outcomes depend on age, associated health problems, tumor histology, and the extent of cancer.[12]

The known major risk factors are age, ethnicity, obesity, and family history.[13] 

The overall incidence increases as people get older, but fortunately, cancer aggressiveness decreases with age.[14]

Prostate cancer risk factors include male gender, older age, positive family history, increased height, obesity, hypertension, lack of exercise, persistently elevated testosterone levels, Agent Orange exposure, and ethnicity.[15][16][17]

5 Alpha-Reductase Inhibitors

These inhibitors, such as finasteride and dutasteride, may decrease low-grade cancer incidence, but they do not appear to affect high-grade risk and thus, do not significantly improve survival. These medications will reduce PSA levels by about 50%, which must be accounted for when comparing sequential prostate-specific antigen (PSA) readings.[18][19][20][21] Taking 5-alpha reductase inhibitors does not appear to affect prostate cancer risk.[22] The Health Professionals Follow-up Study examined the use of 5 alpha-reductase and prostate cancer in 38,000 men followed for over 20 years. Men taking the medication received more PSA tests, prostate examinations, and biopsies, but no association was found regarding the development of lethal disease, overall survival, or cancer-specific survival. However, rates of overall and localized disease were reduced in men taking 5-alpha-reductase medications.[21][23]

Genetics

The cause of prostate cancer is unclear, but genetics is certainly involved. Genetic background, ethnicity, and family history are all known to contribute to prostate cancer risk.[24] In general, patients with genetic or hereditary prostate cancer tend to develop their malignancies at an earlier age, have more rapid progression, are more likely to be locally advanced, and have a higher risk of recurrence after surgery.[25] Hereditary prostate cancer has the highest heritability of any major cancer in men.[26] A family history of hereditary breast and ovarian cancer or Lynch syndrome increases the risk of prostate cancer, indicating a genetic connection.[27][28]