UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Clinical presentation and diagnosis of prostate cancer

Authors
Philip W Kantoff, MD
Mary-Ellen Taplin, MD
Joseph A Smith, MD
Section Editors
Nicholas Vogelzang, MD
W Robert Lee, MD, MS, MEd
Jerome P Richie, MD, FACS
Deputy Editor
Michael E Ross, MD

INTRODUCTION

Prostate cancer is among the most common cancers in men worldwide, with an estimated 1,600,000 cases and 366,000 deaths annually [1]. In the United States, there will be an estimated 161,000 cases and 26,700 deaths in 2017 [2]. The clinical behavior of prostate cancer ranges from a microscopic, well-differentiated tumor that may never be clinically significant to an aggressive, high-grade cancer that ultimately causes metastases, morbidity, and death.

The frequency of diagnosis of prostate cancer had been increasing for many years due largely to the widespread use of serum prostate-specific antigen (PSA) screening. Following the introduction of PSA testing, the incidence of prostate cancer peaked in 1992, declined between 1992 and 1995, and had risen since then at a rate of approximately 1 percent per year until recently. The reasons for this increasing incidence were not known; both genetic and environmental factors have been implicated. The incidence is higher in blacks than in whites in the United States (figure 1).

In 2008, the United States Preventative Services Task Force (USPSTF) recommended against screening for men over the age of 75, giving it a D recommendation. In 2012, the USPSTF recommended against screening for all men, giving it a D recommendation. The recommendation of the USPSTF was based partly on the concern that the benefit of diagnosing and treating prostate cancer may not outweigh the risks of treatment, especially considering that many men would be treated for a cancer not likely to cause them harm. There is still considerable controversy, and many men continue to be screened for prostate cancer, although the rate of screening and diagnosis of prostate cancer has declined in all age groups. (See "Risk factors for prostate cancer" and "Screening for prostate cancer".)

An overview of the clinical presentation and initial diagnosis of men with prostate cancer is presented here. The staging system used for prostate cancer, the initial staging evaluation, and management approaches based upon risk are presented separately.

(See "Initial staging and evaluation of men with newly diagnosed prostate cancer", section on 'Introduction'.)

        

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jan 2017. | This topic last updated: Tue Jan 10 00:00:00 GMT+00:00 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Allen C, et al. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol 2016.
  2. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017; 67:7.
  3. Catalona WJ, Richie JP, Ahmann FR, et al. Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6,630 men. J Urol 1994; 151:1283.
  4. Stamey TA. Making the most out of six systematic sextant biopsies. Urology 1995; 45:2.
  5. Collin SM, Metcalfe C, Donovan JL, et al. Associations of sexual dysfunction symptoms with PSA-detected localised and advanced prostate cancer: a case-control study nested within the UK population-based ProtecT (Prostate testing for cancer and Treatment) study. Eur J Cancer 2009; 45:3254.
  6. Moore CM, Robertson NL, Arsanious N, et al. Image-guided prostate biopsy using magnetic resonance imaging-derived targets: a systematic review. Eur Urol 2013; 63:125.
  7. Siddiqui MM, Rais-Bahrami S, Truong H, et al. Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy. Eur Urol 2013; 64:713.
  8. Crawford ED, Schutz MJ, Clejan S, et al. The effect of digital rectal examination on prostate-specific antigen levels. JAMA 1992; 267:2227.