S/S

• Early: Asymptomatic
  • diagnosed through PSA-driven biopsy
• Prostate Nodule on DRE
  • has at least 50% probability of positive biopsy, regardless of PSA
• Late:
  • Urinary retention
  • Preferential metastasis to bone, especially lumbar and sacral spine
    • Bone Pain
    • Low Back Pain
• Constitutional symptom

RF

• Older Adult > 65 (RF)
• African, Caribbean
• Obesity
• FHx
  • 1.7x with one first-degree relative
  • BRCA1/2 (2)

Investigation

Screening

• PSA for screening
  • Evidence now supports PSA screening benefits, particularly from the European study, as data has matured

Dx

• Trans-rectal US guided Biopsy guided Biopsy
  • High PSA = Biopsy
  • Palpable nodule = Biopsy (50% chance being malignant
  • MR imaging high PIRAD scale = Biopsy

Staging

• MRI pre-biopsy for staging (PI-RAD)
• PET/CT CAP, Bone Scan for staging
  • Metastasis usually affects lymph nodes or bone, typically the axial skeleton

Treatment

• Local
  • Radical Prostatectomy
  • Radiation Therapy
  • Active surveillance has replaced radical treatment for low-grade prostate cancers, significantly reducing morbidity associated with diagnosis