Prostate cancer is the most common cancer in men in the US, and most cases grow slowly and are found by PSA testing before any symptoms. Risk rises with age, Black ancestry and family history or inherited genes such as BRCA2, and care ranges from active surveillance to surgery, radiation and hormone therapy.
Key symptoms
- Usually no symptoms in early disease
- Urinary symptoms such as a slow stream or frequency, more often from an enlarged prostate
- Blood in the urine or semen
- Bone pain, weight loss or fatigue in advanced disease
What you find on exam
- Digital rectal exam: hard, irregular or nodular prostate
- Palpable bladder if there is obstruction
- Bone tenderness over the spine
- Leg strength and sensation if there is back pain
Tests
- PSA blood test; shared decision about screening from age 55 to 69
- Prostate MRI to target the biopsy
- Prostate biopsy with Gleason score and Grade Group
- Staging in higher risk disease: PSMA PET, bone scan or CT
Treatment basics
- Low risk: active surveillance with PSA, MRI and repeat biopsy
- Localized disease: radical prostatectomy or radiation therapy
- Higher risk or advanced: androgen deprivation therapy such as leuprolide, often with abiraterone or enzalutamide
- Chemotherapy such as docetaxel and other options for advanced disease
- Manage side effects: urine leakage, erectile dysfunction and bone health
Red flags
- Back pain with leg weakness, numbness or bladder changes (spinal cord compression)
- Urinary retention or kidney failure from obstruction
- New bone pain or high calcium in a man with known prostate cancer
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.