prostate cancer

Prostate cancer is a common malignancy in older men. Prostate cancer typically affects older men (average age at diagnosis is 67 years) and is more common among Black men than White men.1 More than half of prostate cancer risk is due to genetic factors. Prostate cancer is the second most common cause of cancer in men worldwide, with about 1.5 million cases diagnosed in 2021. In the US, 3.4 million men were living with prostate cancer in 2021.

Author/s:

Rebecca Voelker, MSJ

Prostate Cancer: A Review

Erin Blanchette — Wed, 12 Mar 2025 21:19:16 +0000

Date Added:

March 12, 2025

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

March 10, 2025

URL:

Prostate Cancer: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.0228

Keywords

prostate

prostate cancer

adenocarcinoma

PMID (1):

40063046

MeSH

Prostate-Specific Antigen

An evidence-based review of our current understanding of prostate cancer. James W. Mold, MD, MPH

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Importance: Prostate cancer is the most common nonskin cancer in men in the US, with an estimated 299 010 new cases and 35 250 deaths in 2024. Prostate cancer is the second most common cancer in men worldwide, with 1 466 680 new cases and 396 792 deaths in 2022.

Observations: The most common type of prostate cancer is adenocarcinoma (≥99%), and the median age at diagnosis is 67 years. More than 50% of prostate cancer risk is attributable to genetic factors; older age and Black race (annual incidence rate, 173.0 cases per 100 000 Black men vs 97.1 cases per 100 000 White men) are also strong risk factors. Recent guidelines encourage shared decision-making for prostate-specific antigen (PSA) screening. At diagnosis, approximately 75% of patients have cancer localized to the prostate, which is associated with a 5-year survival rate of nearly 100%. Based on risk stratification that incorporates life expectancy, tumor grade (Gleason score), tumor size, and PSA level, one-third of patients with localized prostate cancer are appropriate for active surveillance with serial PSA measurements, prostate biopsies, or magnetic resonance imaging, and initiation of treatment if the Gleason score or tumor stage increases. For patients with higher-risk disease, radiation therapy or radical prostatectomy are reasonable options; treatment decision-making should include consideration of adverse events and comorbidities. Despite definitive therapy, 2% to 56% of men with localized disease develop distant metastases, depending on tumor risk factors. At presentation, approximately 14% of patients have metastases to regional lymph nodes. An additional 10% of men have distant metastases that are associated with a 5-year survival rate of 37%. Treatment of metastatic prostate cancer primarily relies on androgen deprivation therapy, most commonly through medical castration with gonadotropin-releasing hormone agonists. For patients with newly diagnosed metastatic prostate cancer, the addition of androgen receptor pathway inhibitors (eg, darolutamide, abiraterone) improves survival. Use of abiraterone improved the median overall survival from 36.5 months to 53.3 months (hazard ratio, 0.66 [95% CI, 0.56-0.78]) compared with medical castration alone. Chemotherapy (docetaxel) may be considered, especially for patients with more extensive disease.

Conclusions and relevance: Approximately 1.5 million new cases of prostate cancer are diagnosed annually worldwide. Approximately 75% of patients present with cancer localized to the prostate, which is associated with a 5-year survival rate of nearly 100%. Management includes active surveillance, prostatectomy, or radiation therapy, depending on risk of progression. Approximately 10% of patients present with metastatic prostate cancer, which has a 5-year survival rate of 37%. First-line therapies for metastatic prostate cancer include androgen deprivation and novel androgen receptor pathway inhibitors, and chemotherapy for appropriate patients.

Author/s:

Ruben Raychaudhuri, Daniel W Lin, R Bruce Montgomery

Patient-Reported Outcomes 12 Years after Localized Prostate Cancer Treatment

Aubrey Delammermore — Wed, 05 Apr 2023 05:00:00 +0000

Date Added:

April 5, 2023

Journal/Publication:

New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

March 11, 2023

Issue:

Volume:

URL:

Patient-Reported Outcomes 12 Years after Localized Prostate Cancer Treatment

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/EVIDoa2300018

Keywords

Androgens

Prostatectomy

Patient Reported Outcome Measures

MeSH

Evidence of long-term quality of life-relevant outcome after various treatments for localized prostate cancer from an RCT. James W. Mold, MD, MPH

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Long-term patient-reported outcomes are needed to inform treatment decisions for localized prostate cancer.

METHODS
Patient-reported outcomes of 1643 randomly assigned participants in the ProtecT (Prostate Testing for Cancer and Treatment) trial were evaluated to assess the functional and quality-of-life impacts of prostatectomy, radiotherapy with neoadjuvant androgen deprivation, and active monitoring. This article focuses on the outcomes of the randomly assigned participants from 7 to 12 years using mixed effects linear and logistic models.

RESULTS
Response rates exceeded 80% for most measures. Among the randomized groups over 7 to 12 years, generic quality-of-life scores were similar. Among those in the prostatectomy group, urinary leakage requiring pads occurred in 18 to 24% of patients over 7 to 12 years, compared with 9 to 11% in the active monitoring group and 3 to 8% in the radiotherapy group. In the prostatectomy group, 18% reported erections sufficient for intercourse at 7 years, compared with 30% in the active monitoring and 27% in the radiotherapy groups; all converged to low levels of potency by year 12. Nocturia (voiding at least twice per night) occurred in 34% in the prostatectomy group compared with 48% in the radiotherapy group and 47% in the active monitoring group at 12 years. Fecal leakage affected 12% in the radiotherapy group compared with 6% in the other groups by year 12. The active monitoring group experienced gradual age-related declines in sexual and urinary function, avoiding radical treatment effects unless they changed management.

CONCLUSIONS
ProtecT provides robust evidence about continued impacts of treatments in the long term. These data allow patients newly diagnosed with localized prostate cancer and their clinicians to assess the trade-offs between treatment harms and benefits and enable better informed and prudent treatment decisions. (Funded by the UK National Institute for Health and Care Research Health Technology Assessment Programme projects 96/20/06 and 96/20/99; ISRCTN number, ISRCTN20141297; ClinicalTrials.gov number, NCT02044172.)

Author/s:

Donovan, J. L., Hamdy, F. C., Lane, J. A., Young, G. J., Metcalfe, C., Walsh, E. I., Davis, M., Steuart-Feilding, T., Blazeby, J. M., Avery, K. N., Martin, R. M., Bollina, P., Doble, A., Doherty, A., Gillatt, D., Gnanapragasam, V., Hughes, O., Kockelbergh, R., Kynaston, H., Paul, A., Paez, E., Powell, P., Rosariom D. J., Rowe, E., Manson, M., Catto, J. W., Peters, T. J., Wade, J., Turner, E. L., Williams, N. J., Oxley, J., Staffurth, J., Bryant, R. J., Neal, D. E.

Association of Treatment With 5α-Reductase Inhibitors and Prostate Cancer Mortality Among Older Adults

John Bayhi — Sat, 19 Oct 2019 15:06:17 +0000

Date Added:

October 19, 2019

Journal/Publication:

JAMA Network Open

Publisher:

American Medical Association

Publication Date:

October 18, 2019

URL:

Association of Treatment With 5α-Reductase Inhibitors and Prostate Cancer Mortality Among Older Adults

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2019.13612

Keywords

prostate cancer

5-alpha-reductase inhibitors

5α-Reductase Inhibitors

5-ARIs

prostate-specific antigen

PSA

PMID (1):

31626312

MeSH

Humans

male

Prostate-Specific Antigen

Prostactic Hyperplasia

5-alpha-reductase inhibitors reduce PSA levels, even in patients with prostate cancer, so beware. James W. Mold, MD, MPH

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5α-reductase inhibitors (5-ARIs) are used to treat benign prostatic enlargement, a common condition causing urinary outflow obstruction. They also reduce prostate-specific antigen (PSA) by approximately 50%. Our group has recently published that among US military veterans, 5-ARIs are associated with delays in prostate cancer (PC) diagnoses, higher grade and stage at presentation, and worse PC-specific mortality (PCSM), presumably because of misinterpreted PSA values. We hypothesized that these results are generalizable to the broader US population.

Author/s:

Kumar, A, Nalawade, V, Riviere, P, Sarkar, RR, Parsons, JK, Murphy, JD, Rose, BS

Testing of a Tool for Prostate Cancer Screening Discussions in Primary Care

John Bayhi — Thu, 26 Sep 2019 13:53:04 +0000

Date Added:

September 30, 2019

Journal/Publication:

Frontiers in Oncology

Publisher:

Frontiers Media S.A.

Publication Date:

June 28, 2018

Type:

Clinical Decision Aids

Format:

Article

DOI (1):

10.3389/fonc.2018.00238

Keywords

cancer screening

clinical decision-making

prostate cancer

prostate-specific antigen

shared decision-making

PMID (1):

30003062

MeSH

early detection of cancer

Surveys and Questionnaires

This tool was developed and tested in primary care settings as a way to facilitate discussions about prostate cancer screening. Both clinicians and patients seemed to like it. James W. Mold, MD, MPH

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The link to the study is available here: https://www.ncbi.nlm.nih.gov/pubmed/30003062

BACKGROUND:

As prostate cancer (PCa) screening decisions often occur in outpatient primary care, a brief tool to help the PCa screening conversation in busy clinic settings is needed.

METHODS:

A previously created 9-item tool to aid PCa screening discussions was tested in five diverse primary care clinics. Fifteen providers were recruited to use the tool for 4 weeks, and the tool was revised based upon feedback. The providers then used the tool with a convenience sample of patients during routine clinic visits. Pre- and post-visit surveys were administered to assess patients' knowledge of the option to be screened for PCa and of specific factors to consider in the decision. McNemar's and Stuart-Maxwell tests were used to compare pre-and post-survey responses.

RESULTS:

14 of 15 providers completed feedback surveys and had positive responses to the tool. All 15 providers then tested the tool on 95 men aged 40-69 at the five clinics with 2-10 patients each. The proportion of patients who strongly agreed that they had the option to choose to screen for PCa increased from 57 to 72% (p = 0.018) from the pre- to post-survey, that there are factors in the personal or family history that may affect PCa risk from 34 to 47% (p = 0.012), and that their opinions about possible side effects of treatment for PCa should be considered in the decision from 47 to 61% (p = 0.009).

CONCLUSION:

A brief conversation tool for the PCa screening discussion was well received in busy primary-care settings and improved patients' knowledge about the screening decision.

Author/s:

Misra-Hebert, AD, Hom, G, Klein, EA, Bauman, JA, Gupta, N, Ji, X, Stephenson, AJ, Jones, JS, Kattan, Kattan, MW

How Will Treating My Early-Stage Prostate Cancer Affect My Quality of Life?

John Bayhi — Tue, 16 Jul 2019 20:56:31 +0000

Date Added:

July 16, 2019

Publisher:

Patient-Centered Outcomes Research Institute

Publication Date:

September 21, 2019

URL:

Evidence Update for Patients: Prostate Cancer

Type:

Patient Education Materials

Keywords

This is a concise comparison of the quality of life results of prostatectomy vs. radiation therapy for early-stage prostate cancer for patients. James W. Mold, MD, MPH

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Early-stage prostate cancer can be treated in different ways. The three main ways are active surveillance, surgery, and radiotherapy. Active surveillance means having your prostate checked every few months to make sure the cancer is not spreading. Surgery would take out the prostate, and radiotherapy uses high-energy rays to kill cancer cells in the prostate.

Two recent PCORI-funded studies compare the effects of these choices on the quality of life for men with early-stage prostate cancer. These studies looked at three effects treatment might have on a man’s quality of life. These are problems having sex, urinary problems, and bowel problems.

Author/s:

Patient-Centered Outcomes Research Institute

Current Treatments for Localized Prostate Cancer and Symptom-Related Quality of Life

John Bayhi — Tue, 16 Jul 2019 20:46:11 +0000

Date Added:

July 16, 2019

Publisher:

Patient-Centered Outcomes Research Institute

Publication Date:

September 21, 2017

URL:

Current Treatments for Localized Prostate Cancer and Symptom-Related Quality of Life

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

Keywords

This is a concise comparison of the quality of life results of prostatectomy vs. radiation therapy for early-stage prostate cancer for clinicians. James W. Mold, MD, MPH

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Given the evidence of high 5- and 10-year survivorship rates for localized prostate cancer, the effect of treatment on symptom-related quality of life is an important consideration for men choosing among available treatment options. Two PCORI-funded studies published in the March 21, 2017 issue of JAMA compare the impact of current treatments on symptom-related quality of life for men with localized prostate cancer. Quality of life scores refer to symptoms, how much men were bothered by symptoms, or a combination of the two. The studies looked at observed outcomes from a combined total of 3,600 men for periods of two and three years following treatment. This evidence offers information that can help patients make treatment decisions.

Author/s:

Patient-Centered Outcomes Research Institute

How Will Treating My Early-Stage Prostate Cancer Affect My Quality of Life?

Tracy Ashby — Wed, 23 Jan 2019 06:00:00 +0000

Date Added:

January 23, 2019

Journal/Publication:

PCORI

Publisher:

Patient-Centered Outcomes Research Institute

Publication Date:

January 1, 2017

URL:

How Will Treating My Early-Stage Prostate Cancer Affect My Quality of Life?

Type:

Patient Education Materials

Format:

Article

Keywords

MeSH

This is a summary of the common treatment options for prostate cancer and a comparison of their adverse effects.

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Early-stage prostate cancer can be treated in different ways. The three main ways are active surveillance, surgery, and radiotherapy. Active surveillance means having your prostate checked every few months to make sure the cancer is not spreading. Surgery would take out the prostate, and radiotherapy uses high-energy rays to kill cancer cells in the prostate.

Two recent PCORI-funded studies compare the effects of these choices on the quality of life for men with early stage prostate cancer. These studies looked at three effects treatment might have on a man’s quality of life. These are problems having sex, urinary problems, and bowel problems.

Radical Prostatectomy or Watchful Waiting in Prostate Cancer - 29-Year Follow-up

Tracy Ashby — Sun, 13 Jan 2019 06:00:00 +0000

Date Added:

January 13, 2019

Journal/Publication:

The New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

December 13, 2018

Issue:

Volume:

379

Pages:

2319-2329

URL:

Radical Prostatectomy or Watchful Waiting in Prostate Cancer - 29-Year Follow-up.

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/NEJMoa1807801

Keywords

prostate cancer

radical prostatectomy

PMID (1):

30575473

MeSH

prostatectomy

prostatic neoplasms

This RCT comparing prostatectomy to watchful waiting in men with a long life expectancy otherwise found, after an average of 23 years of follow-up, that prostatectomy extended life by an average of 2.9 years.

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BACKGROUND

Radical prostatectomy reduces mortality among men with clinically detected localized prostate cancer, but evidence from randomized trials with long-term follow-up is sparse.

METHODS

We randomly assigned 695 men with localized prostate cancer to watchful waiting or radical prostatectomy from October 1989 through February 1999 and collected follow-up data through 2017. Cumulative incidence and relative risks with 95% confidence intervals for death from any cause, death from prostate cancer, and metastasis were estimated in intention-to-treat and per-protocol analyses, and numbers of years of life gained were estimated. We evaluated the prognostic value of histopathological measures with a Cox proportional-hazards model.

RESULTS

By December 31, 2017, a total of 261 of the 347 men in the radical-prostatectomy group and 292 of the 348 men in the watchful-waiting group had died; 71 deaths in the radical-prostatectomy group and 110 in the watchful-waiting group were due to prostate cancer (relative risk, 0.55; 95% confidence interval [CI], 0.41 to 0.74; P<0.001; absolute difference in risk, 11.7 percentage points; 95% CI, 5.2 to 18.2). The number needed to treat to avert one death from any cause was 8.4. At 23 years, a mean of 2.9 extra years of life were gained with radical prostatectomy. Among the men who underwent radical prostatectomy, extracapsular extension was associated with a risk of death from prostate cancer that was 5 times as high as that among men without extracapsular extension, and a Gleason score higher than 7 was associated with a risk that was 10 times as high as that with a score of 6 or lower (scores range from 2 to 10, with higher scores indicating more aggressive cancer).

CONCLUSIONS

Men with clinically detected, localized prostate cancer and a long life expectancy benefited from radical prostatectomy, with a mean of 2.9 years of life gained. A high Gleason score and the presence of extracapsular extension in the radical prostatectomy specimens were highly predictive of death from prostate cancer. (Funded by the Swedish Cancer Society and others.)

Author/s:

Bill-Axelson, Anna, Holmberg, Lars, Garmo, Hans, Taari, Kimmo, Busch, Christer, Nordling, Stig, Häggman, Michael, Andersson, Swen-Olof, Andrén, Ove, Steineck, Gunnar, Adami, Hans-Olov, Johansson, Jan-Erik