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Key Clinical Updates in Prostate Cancer
The 2023 AUA/SUO guidelines on early detection of prostate cancer advise clinicians to engage in shared decision-making with men whom prostate cancer screening would be appropriate, incorporating the patient’s values and preferences. This update provides important information for clinicians on deciding when to start screening men and how often. (See https://www.auanet.org/guidelines-and-quality/guidelines/early-detection-of-prostate-cancer-guidelines.)
Wei JT et al. J Urol. [PMID: 37096582]
The EMBARK clinical trial demonstrated improved metastasis-free survival with enzalutamide with or without ADT over ADT alone for men with PSA-recurrent, non-metastatic prostate cancer after primary therapy (radiation or prostatectomy) and rapid PSA doubling time of less than 9 months.
Freedland SJ et al. N Engl J Med. [PMID: 37851874]
Guidelines recommend genomics testing for all men with metastatic prostate as men who are found to have specific germline or somatic pathogenic variants may benefit from personalized treatment strategies.
Tuffaha H et al. Prostate Cancer Prostatic Dis. [PMID: 37202470]
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GENERAL CONSIDERATIONS
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Prostate cancer is the most common noncutaneous cancer and the second leading cause of cancer-related death in American men with an estimated 288,300 new prostate cancer diagnoses and 34,700 prostate cancer deaths in 2023. The clinical incidence, however, does not match the prevalence of the disease. Autopsy studies have demonstrated that more than 40% of men over age 50 years have prostate cancer, and its prevalence increases with age with 30% of men aged 60–69 years and 67% of men aged 80–89 years harboring the disease at autopsy. Prostate cancer is an extremely heterogenous disease and most of these occult cancers are small, indolent, and organ-confined cancers with little potential for regional or metastatic disease. Although the global prevalence of prostatic cancer at autopsy is relatively consistent, the clinical incidence varies considerably (highest in North America, Europe, the Caribbean, Australia/New Zealand, and Southern Africa, and lowest in Northern Africa and Asia). Globally, prostate cancer is the second most common malignancy in men and the fifth leading cause of cancer mortality. The global differences in prostate cancer incidence and mortality likely reflect variations in screening and access to health care as well as potentially dietary or environmental factors. A 50-year-old American man has a lifetime risk of 40% for latent cancer, a 16% risk for developing clinically apparent cancer, and a 2.9% risk of death due to prostatic cancer. Black race, family history of prostatic cancer, and history of high dietary fat intake are risk factors for prostate cancer.
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A. Symptoms and Signs
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Most prostate cancers are asymptomatic and are diagnosed because of elevations in serum PSA. However, some cases of prostate cancer are diagnosed based on discrete nodules or areas of induration within the prostate on ...