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Clinical presentation and diagnosis of prostate cancer

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 Editors
Judith A Melin, MA, MD, FACP
Michael E Ross, MD


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'.)

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Literature review current through: Nov 2017. | This topic last updated: Jan 10, 2017.
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