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The following updates were made on January 26, 2021:

  • Key Concept 6 revised to include current treatment options for metastatic castration-naive disease

  • General Approach to Treatment section updated to include updated information about genetic testing

  • Antiandrogen sections updated to describe current use of second-generation antiandrogens

  • Tables 148-6 and 148-7 updated with new or updated treatment options (abiraterone, relugolix, pembrolizumab, olaparib, and rucaparib)

  • Secondary Hormonal Manipulations section updated to describe current use of treatments


For the Chapter in the Schwinghammer, Handbook (not Wells Handbook anymore) please go to Chapter 64, Prostate Cancer.



  • image Prostate cancer is the most frequent cancer in men in the United States. African American ancestry, family history, and increased age are the primary risk factors for prostate cancer.

  • image Screening recommendations for prostate cancer have changed and digital rectal examination (DRE) and prostate-specific antigen (PSA) are no longer recommended for patients without a discussion with their clinician on the risks versus benefits of screening.

  • image The prognosis for prostate cancer patients depends on the histologic grade, the tumor size, and the disease stage. More than 85% of patients with localized disease but less than 1% of those with metastatic disease can be cured.

  • image Androgen deprivation therapy (ADT) with a luteinizing hormone-releasing hormone (LHRH) agonist plus an antiandrogen should be used prior to radiation therapy for patients with locally advanced prostate cancer to improve outcomes over radiation therapy alone.

  • image Systemic therapy for nonmetastatic castration-naive disease, whereby the disease has not yet become resistant to ADT therapy, may include either orchiectomy, LHRH agonist with or without an antiandrogen, LHRH antagonist, or observation.

  • image ADT in addition to one of the following: docetaxel, abiraterone, enzalutamide, or apalutamide improve survival for patients with metastatic castration-naive disease.

  • image Chemotherapy with docetaxel and prednisone improves survival in patients with castrate-resistant prostate cancer and is considered a first-line therapy option for these patients. Other effective agents include apalutamide, enzalutamide and abiraterone.


Preclass Engaged Learning Activity

Conduct a brief literature search and retrieve the most recent prostate cancer screening guidelines from the American Urological Association, the American Cancer Society, and the US Preventive Services Task Force. Compare and contrast the different prostate cancer recommendations. Review the data behind the recommendations from these consensus guidelines and be prepared to discuss them in class. This activity is intended to help you to become familiar with the updated screening recommendations and understand how these recommendations were made. What are the potential benefits and harms of screening patients?


Prostate cancer is the most commonly diagnosed cancer in American men.1 For most men, prostate cancer has an indolent course, and treatment options for early disease include expectant management, surgery, or radiation. With expectant management, patients are ...

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