What is Prostate Cancer?

Prostate cancer (PCa)

Prostate cancer (PCa) is the most common malignant tumour affecting the urinary system. In 2020, it ranked fourth in incidence among all cancers, comprising 7.3% of all new cancer cases. Notably, PCa was the second most frequently diagnosed cancer in men globally, accounting for 14.1% of new cancer cases in males1.

Castration-Resistant Prostate Cancer (CRPC)

Castration-Resistant Prostate Cancer (CRPC) is characterised by disease progression despite androgen deprivation therapy, with serum testosterone maintained at castration levels. Disease progression can be monitored through prostate-specific antigen (PSA) testing or imaging evidence2.

Metastatic Prostate Cancer (PCa)

Metastasis occurs when cancer spreads from its original site to distant parts of the body. Metastatic PCa includes metastatic hormone-sensitive prostate cancer (mHSPC) and metastatic castration-resistant prostate cancer (mCRPC). These subtypes of metastatic PCa exhibit the characteristics of hormone sensitivity2.

Generally, CRPC is relatively late-stage of the disease.

Epidemiology

Incidence

In 2020, there were over 1,414,259 estimated new cases of PCa worldwide, with an age-standardised incidence of 37.5 per 100,000 males in higher human development index countries1.

Prevalence

5% (3-8%) prevalence at age <30 years to a prevalence of 59% (48-71%) by age >79 years3.

Mortality

PCa also significantly contributes to cancer-related deaths, with 375,304 deaths in 2020 worldwide, positioning as the fifth most common cause of cancer-related mortality in men1.

Demographic Profiles

Possible Causes And Risk Factors

Genetic Factors

Family history of malignancy, genetic mutations (e.g. BRCA1 and BRCA2) and cancer predisposition syndromes (Lynch syndrome), ethnicity and race4.

Signs And Symptoms

Lower urinary tract symptoms (LUTS)
Nocturia (frequent need to urinate at night)
Poor urinary stream
Erectile dysfunction
Visible haematuria (blood in urine)
Usually, prostate cancer are asymptomatic at early stages. Clinical signs that are possibly associated with prostate cancer include an elevated PSA on laboratory testing and an abnormal prostate finding on digital rectal examination4,5.

Diagnosis

Abnormal digital rectal exam

Initial Suspicion

Elevated PSA level
Biopsies

Definitive Diagnosis11, 12

Multi-parametric magnetic resonance imaging (mpMRI)

Standard Treatment

Factors related to Prognosis

Age and Overall Health

Younger individuals with better overall health often tolerate treatments well and may have a more favourable prognosis. However, age alone should not dictate treatment decisions, and individual circumstances should be taken into account8.

Stage of Prostate Cancer

This refers to the extent of the disease and its spread beyond the prostate gland. The most commonly used staging system is the TNM system, assessing tumour size (T), lymph node involvement (N), and the presence of metastasis (M). Generally, earlier stages (T1 or T2) have a more favourable prognosis13.

Grade of Prostate Cancer

This is determined by the Gleason score (ranges: 6-10), which evaluates the microscopic appearance of cancer cells. Lower scores indicate less aggressive tumours and a more favourable prognosis8.

Stage of Prostate Cancer

This refers to the extent of the disease and its spread beyond the prostate gland. The most commonly used staging system is the TNM system, assessing tumour size (T), lymph node involvement (N), and the presence of metastasis (M). Generally, earlier stages (T1 or T2) have a more favourable prognosis8.

Grade of Prostate Cancer

This is determined by the Gleason score (ranges: 6-10), which evaluates the microscopic appearance of cancer cells. Lower scores indicate less aggressive tumours and a more favourable prognosis8.

PSA Level

PSA is a protein produced by the prostate gland. Elevated PSA levels can indicate prostate-related conditions, including prostate cancer. Higher PSA levels may suggest a higher risk or more advanced stage of prostate cancer. However, further evaluation is required together with PSA levels to define and diagnose the stage of prostate cancer8. A faster rise in PSA levels over time may indicate more aggressive disease or potential recurrence after treatment. Monitoring Prostate-Specific Antigen Doubling Time (PSADT) can help guide treatment decisions and monitor disease progression8.

Factors

Age and Overall Health
Stage of Prostate Cancer
Grade of Prostate Cancer
Stage of Prostate Cancer
Grade of Prostate Cancer
PSA Level