A 65-year-old man in good health comes to the office having had a prostate specific antigen (PSA) test performed at a local health fair. He reports a normal voiding pattern and normal erectile function with no evidence of weight loss or bone pain. He has no major medical problems but does have a strong family history of prostate cancer. His PSA is 9.3 ng/mL and he chooses to have a prostate biopsy. Pathology demonstrates prostate cancer with a Gleason score of 6 (Figure 73-1).
Microscopic image of biopsy demonstrating glands with enlarged nuclei and prominent nucleoli (hematoxylin and eosin [H&E] staining). The patient was diagnosed with prostate cancer with a Gleason score of 6. (Courtesy of E.J. Mayeaux, Jr., MD.)
Prostate cancer is a very common cancer in men. Secondary to widespread testing, we have seen a stage migration in prostate cancer. Most patients are diagnosed with asymptomatic, clinically localized disease. Multiple factors such as Gleason score, PSA level, stage at diagnosis, and life expectancy are all factors applied to risk stratify patients associated with varying possibilities of achieving a cure. It is especially important to consider life expectancy prior to offering PSA screening.
- Prostate cancer (Figure 73-2) is the leading cancer in U.S. men and the second leading cause of cancer deaths in men.1
- It is the second most common cancer in men worldwide, with an estimated 900,000 cases and 258,000 deaths in 2008.2
- Incidence is increased with age.
- The risk of developing prostate cancer increases at age 40 years in black men and in those who have a first-degree relative with prostate cancer.
- The risk of developing prostate cancer begins to increase at age 50 years in white men who have no family history of the disease.3
- There is no peak age or modal distribution.
- The highest incidence of prostate cancer in the world is found in African American men, who have approximately a 9.8% lifetime risk of developing prostate cancer. There is accompanied by a high rate of prostate cancer mortality (Figure 73-3).
- The lifetime risk of prostate cancer for white men in the United States is 8%.3
- Japanese and mainland Chinese populations have the lowest rates of prostate cancer.
- Socioeconomic status appears to be unrelated to the risk of prostate cancer.
Photograph showing adenocarcinoma on the left lower side of the specimen and bilateral benign prostatic hypertrophy toward the top. (Courtesy of E.J. Mayeaux, Jr., MD.)
Age-adjusted U.S. prostate cancer mortality rates by race and ethnicity in males older than the age of 50 years. Note the higher mortality in blacks.