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Clinical Presentation
Patients with prostate cancer present may with weak urinary stream, incomplete bladder emptying, polyuria, nocturia, hematuria, erectile dysfunction, pelvic pain, back pain, chest pain, lower extremity weakness or numbness, and loss of bladder or bowel control.
Physical Examination
Digital Rectal Examination (DRE)
A DRE detects prostatic enlargement with a volume of
≥0.2 mL. Abnormal DRE results are associated with high Gleason scores and may
be considered for prostate biopsy.
Please
see Laboratory Tests and
Ancillaries for further information.
Diagnosis or Diagnostic Criteria
The key examinations for the diagnosis of prostate cancer include prostate-specific antigen (PSA) level, DRE, and prostate biopsy.
Screening
Screening should be done on the following:
- 45-75 years of age at average risk for prostate cancer
- 40-75 years of age at high risk for developing prostate cancer: African descent, germline mutations, with first- or second-degree relatives diagnosed with metastatic prostate, ovarian, breast (female at ≤45 years of age), colorectal, endometrial (≤50 years of age) or pancreatic cancer, ≥2 first- or second-degree relatives diagnosed with prostate, breast, colorectal or endometrial cancer at any age
- Very healthy >75-year-old individuals with minimal or no comorbidities
- With previous PSA level of >1 g/mL at 40 years old or >2 ng/mL taken at 60 years old
- With initial screening which includes PSA and DRE
- With negative results but at
risk for prostate cancer, repeat screening should be done depending on the PSA
& DRE results:
- PSA of <1 ng/mL with normal DRE: 2- to 4-year intervals
- PSA of 1 to 3 ng/mL with normal DRE: 1- to 2-year intervals
- PSA of >3 ng/mL in 40-75 years old and/or very suspicious DRE and PSA of ≥4 ng/mL in >75 years old or very suspicious DRE: PSA, DRE if not done, mpMRI; consider biomarkers
- PSA of <4 ng/mL with normal DRE and no other indications for biopsy: 1- to 4-year intervals