Prostate Cancer - Diagnosis and Management Summary

Prostate Cancer - Diagnosis and Management Summary

 • Adenocarcinoma (95%)

 • Transitional cell carcinoma, carcinosarcoma, basal cell carcinoma, lymphomas, or stromal sarcoma (~5%)

Risk factors:

 • Age, AA race, genetic factors (BRCA1/2 and family history), smoking


 • Discuss PSA with men >50 (DRE not recommended)


 • Path grade w/ Gleason Score (GS)

 • NCCN risk based on age, PSA, GS, stage

 • TNM staging is combined with PSA and GS for AJCC stages I- IV

Once biopsy & diagnosis:

 • TRUS, MRI, biomarkers, evaluate for metastases (CT, radio-nucleotide bone scan)

Treatment - Low risk (T1c/T1-T2a + Gleason score ≤6 + PSA ≤10)

 • Active surveillance (PSA, DRE +/- repeat bx), external beam radiation therapy (EBRT) +/- brachytherapy (BT), or radical prostatectomy (RP) +/- EBRT & ADT

Treatment - Intermediate risk (T2b-T2c or PSA 10-20 or GS 7)

 • EBRT & ADT or EBRT & BT +/- ADT, RP +/- pelvic lymph node dissection (PLND) +/- EBRT +/- ADT

Treatment - High risk (T3a/T3b-T4b or GS 8-10 or PSA >20)

 • EBRT & ADT, ERBT & brachy & ADT, or RP with extended PLND +/- EBRT +/- ADT

Treatment - Metastatic/recurrent 

 • Castration sensitive: ADT (LHRH agonist +/- antiandrogen, LHRH antagonist or orchiectomy) + abiraterone w/ prednisone vs. docetaxel

 • Castration resistant: ADT (testo<50ng/dL) + doxcetaxel (chemo naïve) or cabazitaxel (dox exposed), mitoxantrone + prednisone, androgen disruption; sipuleucel-T, and bone-targeted radium223 or denosumab/zoledronic acid (bone mets, no visceral mets)

#Prostate #Cancer #Diagnosis #Management #Treatment #oncology
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