Prostate Cancer Questions & Answers

Updated: Feb 02, 2021
  • Author: Chad R Tracy, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Questions & Answers

Overview

What is prostate cancer?

What are symptoms of prostate cancer?

Which physical findings are characteristic of advanced prostate cancer?

What is the role of prostate-specific antigen (PSA) testing in the diagnosis of prostate cancer?

What are the limitations of digital rectal exam (DRE) in the diagnosis of prostate cancer?

What is the role of biopsy in the diagnosis of prostate cancer?

What are the prostate cancer screening guidelines?

What are the treatment options for clinically localized prostate cancer?

How is non-localized or recurrent prostate cancer managed

What is prostate cancer?

What are the risk factors for prostate cancer?

How is prostate cancer diagnosed?

Why is prostate cancer screening controversial?

What is the anatomy of the prostate?

What is the anatomy of the blood supply to the prostate?

What is the pathophysiology of prostate cancer?

What is the likely pathogenesis of squamous cell carcinomas (SCCs) in prostate cancer?

Where in the prostate does malignancy arise?

What is the pathophysiology of locally invasive prostate cancer?

What is the mechanism for distant metastasis in prostate cancer?

What is the natural history of prostate cancer?

What is the global incidence of prostate cancer?

What are the incidence of prostate cancer in the US?

What are the racial predilection for prostate cancer?

Which age groups have the highest incidence of prostate cancer?

What are the risk factors for prostate cancer?

What are the established prognostic indicators for prostate cancer?

What is the mortality rate for prostate cancer?

What is the risk of extraprostatic disease in clinically localized prostate cancer?

How is the Cancer of the Prostate Risk Assessment (CAPRA) score calculated for prostate cancer?

What is the significance of the Cancer of the Prostate Risk Assessment (CAPRA) score in the prognosis of prostate cancer?

How does smoking affect the prognosis of prostate cancer?

What is the risk of melanoma in prostate cancer?

How does transitional cell carcinoma (TCC) affect the prognosis for prostate cancer?

Which molecular markers are associated with poor survival in prostate cancer?

What is included in the patient education information for prostate cancer?

Presentation

How is prostate cancer typically identified?

What are the symptoms of prostate cancer?

What are the symptoms of advanced prostate cancer?

What are the signs and symptoms of metastatic and advanced prostate cancer?

What is the role of the physical exam in the diagnosis of prostate cancer?

Which findings suggest locally advanced prostate cancer?

What are the physical findings suggestive of advanced prostate cancer?

What is the role of neurologic exam in the evaluation of prostate cancer?

What is the role of digital rectal exam (DRE) in the evaluation of suspected prostate cancer?

DDX

What are the challenges of the differential diagnosis for advanced prostate cancer?

What is the role of radiologic findings in the differential diagnosis of prostate cancer?

What are the signs of spinal cord decompression in prostate cancer?

How are lymphomas differentiated from prostate cancer?

How are different types of carcinoma differentiated in prostate cancer?

What are the differential diagnoses for Prostate Cancer?

Workup

Which tests are used in prostate cancer screening?

What is the role of needle biopsy in the diagnosis of prostate cancer?

What is the role of blood studies in the diagnosis of prostate cancer?

What is the role of urinalysis in the diagnosis of prostate cancer?

What is the role of CT scanning in the diagnosis of prostate cancer?

What are the role of genetic testing in the workup for prostate cancer?

What is the role of transrectal ultrasonography (TRUS) in prostate cancer screening?

Is digital rectal exam (DRE) effective for prostate cancer screening?

Why is prostate cancer screening controversial?

What are the USPSTF guidelines on prostate cancer screening?

How do the ACS, AUA, EAU and NCCN guidelineson prostate cancer screening compare?

What is prostate-specific antigen (PSA) velocity and how is it used in the diagnosis of prostate cancer?

How are prostate-specific antigen (PSA) tests interpreted in the diagnosis of prostate cancer?

What is the prostate-specific antigen (PSA) cutoff value for the diagnosis of prostate cancer?

Which factors may contribute to over diagnosis and overtreatment of prostate cancer?

Which prostate-specific antigen (PSA) levels in midlife increase the risk of prostate cancer?

How can the accuracy of prostate-specific antigen (PSA) testing for detecting prostate cancer be improved?

How accurate is prostate-specific antigen (PSA) velocity in the diagnosis of prostate cancer?

What are the differences between bound and free prostate-specific antigen (PSA) levels in the detection of prostate cancer?

What is the role of free prostate-specific antigen (PSA) percentage in the diagnosis of prostate cancer?

What is the role of transrectal ultrasonography (TRUS)-guided needle biopsy in the diagnosis of prostate cancer?

What is the role of transperineal prostate biopsy in the diagnosis of prostate cancer?

What is the role of MRI in the diagnosis and management of prostate cancer?

Which histologic changes suggest prostate cancer?

What is the histologic continuum of prostate cancer?

What is the role of prostatic intraepithelial neoplasia (PIN) in the diagnosis of prostate cancer?

Which histologic findings are characteristic of transitional cell carcinoma (TCC) of the prostate?

How is prostate cancer graded and staged?

How are prostate cancer clinic risk groups determined?

What is the basis for prostate cancer treatment selection?

How is transitional cell carcinoma (TCC) of the prostate staged?

What are prediction models for prostate cancer?

What is the role of the Cancer of the Prostate Risk Assessment (CAPRA) score used in the management of prostate cancer?

What is the role of the Prostate Cancer Prevention Trial (PCPT) online risk calculator in the management of prostate cancer?

What is the Whitmore-Jewett classification of prostate cancer?

How has the Whitmore-Jewett classification system for prostate cancer been expanded?

What are the molecular and genetic features of transitional cell carcinoma (TCC) of the prostate?

Which immunoprofile is characteristic of transitional cell carcinoma (TCC) of the prostate?

Treatment

How does the treatment of prostate cancer vary by disease stage?

What are American Urological Association (AUA) guidelines for determining a management strategy for localized prostate cancer?

What are the treatment options for clinically localized prostate cancer?

How is metastatic prostate cancer managed?

How are comparisons made among treatments options for prostate cancer?

What are the surgical options for prostate cancer?

Which forms of radiation therapy are used in the treatment of prostate cancer?

What is the role of androgen deprivation therapy (ADT) in the treatment of prostate cancer?

What are the possible adverse effects of prostate cancer treatment?

What are the treatment options for localized prostate cancer?

How is watchful waiting defined in the treatment of prostate cancer?

How does watchful waiting affect mortality rates in patients with localized prostate cancer?

What is the role of active surveillance in the treatment of localized prostate cancer?

Which definitive therapies are used in the treatment of localized prostate cancer?

What is the role of surgery in the treatment of localized prostate cancer?

What is the role of radiation therapy in the treatment of localized prostate cancer?

Which organizations have issued guidelines on the safe and effective performance of brachytherapy to treat prostate cancer?

What is the role of androgen ablation therapy in the treatment of prostate cancer?

How does the efficacy of radiation therapy compare to surgery for the treatment of prostate cancer??

What is the role of adjuvant radiation therapy following surgery for prostate cancer?

Which therapies are emerging as possible treatments for localized prostate cancer?

How is the continuum of advanced prostate cancer defined?

How is biochemical recurrence of prostate cancer defined?

What are the management options for prostate cancer and PSA (biochemical) failure following treatment?

What are predictive factors of failure following local therapy for prostate cancer?

What is the decision algorithm for the initiation of treatment for biochemical failure in prostate cancer?

How is non-metastatic prostate cancer treated in men with rising PSA after failure of local therapy?

What is the role of salvage systemic therapy after biochemical recurrence of prostate cancer?

What is the primary approach to the treatment of metastatic prostate cancer?

What is the role of a combined androgen blockade (CAB) in the treatment of metastatic prostate cancer?

How do outcomes of early versus delayed treatment compare for advanced prostate cancer?

What is the role of intermittent androgen suppression in the treatment of metastatic prostate cancer?

How is metastatic hormone-sensitive prostate cancer (mHSPC) treated?

What is the role of abiraterone acetate (Zytiga) in the treatment of metastatic hormone-sensitive prostate cancer (mHSPC)?

What is the role of enzalutamide in the treatment of metastatic hormone-sensitive prostate cancer (mHSPC)?

What is the role of docetaxel chemotherapy in the treatment of metastatic hormone-sensitive prostate cancer (mHSPC)?

What is the role of relugolix in the treatment of metastatic hormone-sensitive prostate cancer (mHSPC)?

What is castrate-resistant prostate cancer (CRPC)?

What is the role of testosterone level testing in the diagnosis of castrate-resistant prostate cancer (CRPC)?

What is the median time to symptomatic progression of prostate cancer after a rise in the PSA level?

What is the effect of maintaining hormone suppression in castrate-resistant prostate cancer (CRPC)?

What are the nonchemotherapy options for palliation in prostate cancer?

How should men with non-metastatic castrate-resistant prostate cancer (CRPC) be monitored?

What is the efficacy of docetaxel chemotherapy in the treatment of castrate-resistant prostate cancer (CRPC)?

In addition to docetaxel, which agents are approved for the treatment of castrate-resistant prostate cancer (CRPC)?

What is the benefit of treatment of prostate cancer with docetaxel at the beginning of standard hormone therapy with androgen deprivation therapy (ADT)?

What is the role of cabozantinib for the treatment of prostate cancer?

What is the role of sipuleucel-T in the treatment of prostate cancer?

How is sipuleucel-T administered in the treatment of prostate cancer?

What is the prognosis of prostate cancer following treatment with sipuleucel-T?

What are the limitations of sipuleucel-T in the treatment of prostate cancer?

What are the adverse events of sipuleucel-T in the treatment of prostate cancer?

How is abiraterone acetate used to treat prostate cancer?

What is the efficacy of abiraterone acetate for the treatment of prostate cancer?

What are the possible adverse effects of abiraterone acetate in the treatment of prostate cancer?

What is the role of ultramicronized abiraterone tablet (Yonsa) in the treatment of prostate cancer?

What is the FDA approved expanded use of abiraterone acetate for the treatment of prostate cancer?

What is the role of enzalutamide in the treatment of prostate cancer?

What is the role of cabazitaxel in the treatment of prostate cancer?

What is the role of apalutamide in the treatment of nonmetastatic castrate-resistant prostate cancer?

What is the role of darolutamide in the treatment of nonmetastatic castrate-resistant prostate cancer?

What is the role of rucaparib in the treatment of metastatic castrate-resistant prostate cancer (mCRPC)?

What is the role of olaparib in the treatment of metastatic castrate-resistant prostate cancer (mCRPC)?

How should medications be sequenced in the treatment of prostate cancer?

Which drug should be used for initial treatment of asymptomatic or minimally symptomatic progressive prostate cancer?

What is the FDA approved expanded use of enzalutamide in the treatment of prostate cancer?

When should enzalutamide be used in the treatment of prostate cancer?

What is the prognosis of metastatic prostate cancer following treatment with prostate radiation and androgen deprivation therapy (ADT)?

What is the role of radiation therapy in palliative care of metastatic prostate cancer?

What is the efficacy of radioisotopes to relieve pain from bone metastases in prostate cancer?

What is the role of radium-223 dichloride in the treatment of metastatic prostate cancer?

What is the role of surgery in the treatment of metastic prostate cancer?

What are the adverse effects of surgical and medical castration for the treatment of prostate cancer?

How does androgen deprivation therapy (ADT) affect lean body mass in patients with prostate cancer?

How does androgen ablation affect cardiovascular morbidity and mortality in prostate cancer?

What are the risks of gonadotropin-releasing hormone (GnRH) agonists in the treatment of prostate cancer?

What monitoring is needed for patients taking gonadotropin-releasing hormone (GnRH) agonists for the treatment of prostate cancer?

What are the adverse effects of long-term androgen blockade for the treatment of prostate cancer?

How does the effect of androgen deprivation therapy (ADT) on bone density vary between African-American and Caucasian men treated for advanced prostate cancer?

How does androgen deprivation therapy (ADT) affect the risk for acute kidney injury (AKI) in patients with prostate cancer?

How is osteoporosis treated in men with prostate cancer?

When should palliative care be discussed with patients with prostate cancer?

Which combination therapy is approved for the symptoms of metastatic prostate cancer?

How is urinary retention managed in prostate cancer?

How can the risk of chronic renal failure be reduced during treatment of prostate cancer?

How might hematuria manifest in prostate cancer?

How are blood clots managed in prostate cancer?

How is hematuria managed in prostate cancer?

How is urinary incontinence managed in prostate cancer?

When is a urinary sphincter indicated in the treatment of prostate cancer?

How are rectal complications managed in prostate cancer?

How are spinal cord compression and fractures managed in prostate cancer?

Which specialist consultations are needed for the treatment of prostate cancer?

What is included in the long-term monitoring of prostate cancer?

What is included in watchful waiting in patients with prostate cancer?

How frequently is prostate-specific antigen (PSA) testing performed in patients with prostate cancer?

What is included in patient monitoring following radiation therapy for the treatment of prostate cancer?

When is a biochemical recurrence considered to have occurred in prostate cancer?

How is biochemical recurrence determined in prostate cancer?

Which imaging studies may be performed when biochemical recurrence has occurred in prostate cancer?

What is the role of ProstaScint scan in patients with biochemical recurrence of prostate cancer?

What is the role of positron emission tomography (PET) scanning in patients with biochemical recurrence of prostate cancer?

What is the role of multiparametric magnetic resonance imaging (MP-MRI) in in patients with biochemical recurrence of prostate cancer?

What are the American Cancer Society (ACS) treatment guidelines for prostate cancer survivors?

How is prostate cancer prevented?

Which diet modifications may be beneficial in the prevention of prostate cancer?

How do high-fat diets increase the risk of prostate cancer?

What are the benefits of nutritional supplements for prevention of prostate cancer?

What is the role of physical activity in the prevention of prostate cancer?

What is the effect on mortality rate from diet and activity modifications to prevent prostate cancer?

What are 5-alpha-reductase inhibitors (5-ARIs)?

What is the efficacy of 5-alpha-reductase inhibitors (5-ARIs) in the prevention of prostate cancer?

Which organizations have released guidelines for the use of 5-alpha-reductase inhibitors (5-ARIs) for prostate cancer chemoprevention?

What are the FDA prescribing information revisions for 5-alpha-reductase inhibitors (5-ARIs) in prevention of prostate cancer?

Guidelines

Which organizations have issued guidelines on prostate cancer screening?

How do the prostate cancer screening guidelines differ?

What are the NCCN guidelines on genetic testing following a diagnosis of prostate cancer?

What are the NCCN recommendations for somatic testing of prostate cancer tumors?

What are the guidelines for use of multiparametric magnetic resonance imaging (mpMRI) in the management of prostate cancer?

What are the AUA/ASTRO/SUO treatment guidelines for low-risk localized prostate cancer?

What are the AUA/ASTRO/SUO treatment guidelines for intermediate-risk localized prostate cancer?

What are the AUA/ASTRO/SUO treatment guidelines for high-risk localized prostate cancer?

When does the European Society of Medical Oncology (ESMO) guidelines recommend watchful waiting with delayed hormone therapy for management of prostate cancer?

What are the European Society of Medical Oncology (ESMO) treatment guidelines for prostate cancer?

What are the Cancer Care Ontario guidelines on active surveillance for localized prostate cancer?

What is the Cancer Care Ontario guideline active surveillance protocol for prostate cancer?

What are the National Comprehensive Cancer Network (NCCN) guidelines on bone scanning for the diagnosis of metastatic prostate cancer?

What are the AUA/ASTRO/SUO recommendations for treating advanced prostate cancer?

Which organizations have published treatment guidelines for castration-resistant prostate cancer (CRPC)?

What are the American Society of Clinical Oncology/Cancer Care Ontario treatment guidelines for metastatic castrate-resistant prostate cancer (CRPC)?

How are the American Urological Association treatment guidelines for castrate-resistant prostate cancer (CRPC) constructed?

What are the American Urological Association treatment guidelines for asymptomatic non-metastatic castrate-resistant prostate cancer (CRPC)?

What are the American Urological Association treatment guidelines for asymptomatic or minimally-symptomatic, metastatic castrate-resistant prostate cancer (CRPC) with good performance status and no prior docetaxel chemotherapy?

What are the American Urological Association treatment guidelines for symptomatic, metastatic castrate-resistant prostate cancer (CRPC) with good performance status and prior docetaxel chemotherapy?

What are the American Urological Association treatment guidelines for symptomatic, metastatic castrate-resistant prostate cancer (CRPC) with good performance status and no prior docetaxel chemotherapy?

What are the American Urological Association treatment guidelines for symptomatic, metastatic castrate-resistant prostate cancer (CRPC) with poor performance status and no prior docetaxel chemotherapy?

What are the American Urological Association treatment guidelines for symptomatic, metastatic castrate-resistant prostate cancer (CRPC) with poor performance status and prior docetaxel chemotherapy?

What are the American Urological Association guidelines for bone health treatment in castrate-resistant prostate cancer (CRPC)?

What is the basis for National Comprehensive Cancer Network (NCCN) treatment recommendations for castrate-resistant prostate cancer (CRPC)?

What are the National Comprehensive Cancer Network (NCCN) treatment recommendations for castrate-resistant prostate cancer (CRPC) without distant metastasis?

What are the measures to promote bone health in patients with castrate-resistant prostate cancer (CRPC)?

What are the National Comprehensive Cancer Network (NCCN) treatment recommendations for first-line treatment of metastatic castrate-resistant prostate cancer (CRPC) with no visceral metastases?

What is the National Comprehensive Cancer Network (NCCN) treatment recommendations for second-line treatment castrate-resistant prostate cancer (CRPC) without visceral metastases after enzalutamide or abiraterone?

What is the National Comprehensive Cancer Network (NCCN) treatment recommendations for second-line treatment castrate-resistant prostate cancer (CRPC) without visceral metastases after docetaxel?

What are the National Comprehensive Cancer Network (NCCN) treatment recommendations for first-line treatment of metastatic castrate-resistant prostate cancer (CRPC) with visceral metastases?

What is the National Comprehensive Cancer Network (NCCN) treatment recommendations for second-line treatment of castrate-resistant prostate cancer (CRPC) with visceral metastases after enzalutamide or abiraterone?

What are the EAU, ESTRO and SIOG treatment guidelines for metastatic castrate-resistant prostate cancer (mCRPC)?

What are the ASCO guidelines on imaging of advanced prostate cancer?

What are the ASCO guidelines on the use of next-generation imaging (NGI) in newly diagnosed advanced prostate cancer?

What are the ASCO guidelines on imaging in advanced prostate cancer following prostatectomy?

What are the ASCO guidelines on imaging in advanced prostate cancer following radiation therapy??

What are the ASCO guidelines on imaging in hormone-sensitive metastatic disease?

What are the ASCO guidelines on imaging in nonmetastatic castration-resistant prostate cancer?

What are the ASCO guidelines on imaging in metastatic castration-resistant prostate cancer?

Medications

Which medications are used in the treatment of prostate cancer?

Which medications in the drug class Monoclonal Antibodies, Endocrine are used in the treatment of Prostate Cancer?

Which medications in the drug class Antifungals, Systemic are used in the treatment of Prostate Cancer?

Which medications in the drug class Bisphosphonate Derivatives are used in the treatment of Prostate Cancer?

Which medications in the drug class Antineoplastics, PARP Inhibitors are used in the treatment of Prostate Cancer?

Which medications in the drug class Chemotherapy Modulating Agents are used in the treatment of Prostate Cancer?

Which medications in the drug class Antineoplastics, Hormones are used in the treatment of Prostate Cancer?

Which medications in the drug class Antineoplastics, Anthracenedione are used in the treatment of Prostate Cancer?

Which medications in the drug class Antineoplastics, Antimicrotubular are used in the treatment of Prostate Cancer?

Which medications in the drug class Antineoplastics, GnRH Antagonist are used in the treatment of Prostate Cancer?

Which medications in the drug class Antineoplastics, Antiandrogen are used in the treatment of Prostate Cancer?

Which medications in the drug class Antineoplastics, GnRH Agonist are used in the treatment of Prostate Cancer?

Which medications in the drug class Corticosteroids are used in the treatment of Prostate Cancer?

Which medications in the drug class Radiopharmaceuticals are used in the treatment of Prostate Cancer?