Prostate Cancer

Descriptive text is not available for this image 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

It is estimated that nearly 300,000 men in the United States will be newly diagnosed with carcinoma of the prostate (CaP) in 2024, representing approximately 15% of all new cancer diagnoses.

Prevalence

  • It is estimated that nearly 35,000 men in the United States will die of CaP in 2024, representing 5.7% of all cancer deaths.
  • Median age at diagnosis is 67 years; probability of CaP 11% (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:
    • 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 55 to 69 years old 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 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 1 less person dying, but 50 will develop erectile dysfunction (ED); 15 permanent incontinence

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