Prostate cancer

Prostate cancer is a major health problem. In the UK, it is the most common male cancer and the second most common cause of male cancer death. Its strongest risk factor is increasing age. Virtually all cancers are adenocarcinomas, the grade being indicated by the Gleason score. There are often no presenting symptoms. Investigations such as serum prostate-specific antigen, digital rectal examination, biopsy and, increasingly, magnetic resonance imaging (MRI) are required for diagnosis. Local staging consists of MRI, with computed tomography (CT), bone scanning and, increasingly, positron emission tomography-CT for detecting metastases. Management depends on disease stage, the patient's fitness and their wishes regarding treatment. Active surveillance is encouraged for low-volume and low-grade cancers. For localized prostate cancer, radical prostatectomy and radical radiotherapy offer high cure rates; for example, survival at 10 years can be as high as 90% for a well-differentiated, localized prostate cancer. Hormonal therapy, which lowers or blocks testosterone, is used in locally advanced and metastatic disease; it slows but does not cure metastatic disease. Cytotoxic chemotherapy is increasingly used for castrate-refractory prostate cancer and has been shown to significantly improve overall survival in hormone-naive patients with metastatic prostate cancer.