Renal & Urology

Prostate Cancer

Prostate cancer is often silent while confined to the peripheral zone; PSA and DRE trigger assessment, mpMRI precedes biopsy, and PSA, grade group and stage determine whether surveillance, radical treatment or systemic therapy is appropriate.

Definition

Prostate cancer is a malignant tumour of the prostate, usually adenocarcinoma, ranging from indolent localised disease to aggressive locally advanced or metastatic cancer. Risk is assessed with PSA, grade group and stage.

First principles

Peripheral-zone growth explains the silent presentation

Many prostate cancers arise in the outer part of the gland rather than around the urethra. Early disease may therefore cause no urinary symptoms, while lower urinary tract symptoms, haematuria or erectile dysfunction are not specific and may reflect benign or locally advanced disease.

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