Prostate Cancer
Basics
Description
- The prostate is a male reproductive gland that contributes seminal fluid to the ejaculate.
- Prostate gland is approximately the size of a walnut, 20 to 25 g in an adult male; enlarges after age 50 years
- Three distinct zones delineate the functional anatomy of the prostate: peripheral zone (largest, neighbors rectal wall, palpable on digital rectal exam [DRE], most common location for prostate cancer), central zone (contains the ejaculatory ducts), and transition zone (located centrally, adjacent to the urethra).
- Prostatic epithelial cells produce prostate-specific antigen (PSA), which is used as a tumor marker and in screening.
Epidemiology
Incidence
An estimated 288,300 men in the United States will be newly diagnosed with carcinoma of the prostate (CaP) in 2023, representing 15% of all new cancer diagnoses.
Prevalence
- An estimated 34,700 men in the United States will die of CaP in 2023, representing 5.7% of all cancer deaths.
- Median age at diagnosis is 67 years; probability of CaP 10.9% (1 in 9) ≥70 years
- Autopsy studies find foci of latent CaP in 50% of men in their 8th decade of life.
Etiology and Pathophysiology
- Adenocarcinoma: >95%; nonadenocarcinoma: <5% (most common transitional cell carcinoma)
- Location of CaP: 70% peripheral zone, 20% transitional zone, 5–10% central zone
Risk Factors
Age >50 years, African American race, positive family history
General Prevention
Finasteride use associated with moderate risk reduction in CaP but associated with an increased risk of high-grade disease
ALERT
Screening for prostate cancer is controversial:
Screening for prostate cancer is controversial:
- U.S. Preventive Services Task Force (USPSTF): “For men aged 55 to 69 years, the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one and should include discussion of the potential benefits and harms of screening with their clinician. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening” (1)[A]. USPSTF recommends against PSA screening for men ≥70 years old (1).
- The American Urological Association (AUA) panel recommends for men aged 55 to 69 years shared decision-making between physician and patient regarding PSA screening.
- PSA screening is not recommended in men aged <40 years or any man with <10 years of estimated life expectancy.
- When providing informed consent, data shows if you screen 1,000 men between ages 55 and 69 years:
- 240 will have a positive result; only ~100 will truly have CaP; of the 100 with cancer, 80 will agree to treatment.
- Treatment will result in one less person dying, but 50 will develop erectile dysfunction (ED); 15 permanent incontinence
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Citation
Domino, Frank J., et al., editors. "Prostate Cancer." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117455/all/Prostate_Cancer.
Prostate Cancer. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117455/all/Prostate_Cancer. Accessed September 20, 2024.
Prostate Cancer. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117455/all/Prostate_Cancer
Prostate Cancer [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 September 20]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117455/all/Prostate_Cancer.
* Article titles in AMA citation format should be in sentence-case
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T1 - Prostate Cancer
ID - 117455
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117455/all/Prostate_Cancer
PB - Wolters Kluwer
ET - 33
DB - Medicine Central
DP - Unbound Medicine
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