Review article: prostate cancer

A review article in JAMA today describes risk factors and treatments for prostate cancer, the second most common cancer in men worldwide, with 1,466,680 new cases and 396,792 deaths in 2022. 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, while older age and Black race are also strong risk factors. More than 75% of patients at diagnosis have cancer localized to the prostate, which is associated with a 5-year survival rate of nearly 100%. Treatment of localized prostate cancer depends on risk stratification (defined by serum PSA level, clinical tumor stage based on digital rectal examination, and Gleason score or group), life expectancy, and personal preference. For many patients with low-risk of favorable intermediate-risk disease, active surveillance may be considered. Patients with higher-risk disease may be treated either with radical prostatectomy or radiation therapy. For most patients with newly diagnosed metastatic prostate cancer, androgen deprivation therapy with orchiectomy or a gonadotropin agonist or antagonist should be used. Treatments should also include androgen deprivation in combination with an androgen receptor pathway inhibitor (such as abiraterone or enzalutamide). The addition of chemotherapy (docetaxel) may be considered for some patients, especially those with more advanced disease.