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Epidemiology, Staging and Management of Prostate Cancer

1
Department of Hematology-Oncology, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA 15232, USA
2
Department of Medicine, Nephrology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
3
Department of Medicine, Hematology-Oncology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
4
Plains Regional Medical Group Internal Medicine, Clovis, NM 88101, USA
5
Department of Pulmonary and Critical Care Medicine, Sentara Virginia Beach General Hospital, Virginia Beach, VA 23454, USA
6
Department of Internal Medicine, Sovah Health, Martinsville, VA 24112, USA
7
Hematology-Oncology, Allegheny Health Network, Pittsburgh, PA 15212, USA
*
Author to whom correspondence should be addressed.
Med Sci (Basel) 2020, 8(3), 28; https://doi.org/10.3390/medsci8030028
Received: 5 June 2020 / Revised: 9 July 2020 / Accepted: 10 July 2020 / Published: 20 July 2020
(This article belongs to the Section Cancer and Cancer-Related Research)
Prostate cancer is the second most common and fifth most aggressive neoplasm among men worldwide. It is particularly incident in high human development index (HDI) nations, with an estimated one in seven men in the US receiving a prostate cancer diagnosis in their lifetime. A rapid rise and then fall in prostate cancer incidence in the US and Europe corresponded to the implementation of widespread prostate specific antigen (PSA) testing in 1986 and then subsequent fall from favor due to high rates of false positives, overdiagnosis, and overtreatment (as many as 20–50% of men diagnosed could have remained asymptomatic in their lifetimes). Though few risk factors have been characterized, the best known include race (men of African descent are at higher risk), genetics (e.g., BRCA1/2 mutations), and obesity. The Gleason scoring system is used for histopathological staging and is combined with clinical staging for prognosis and treatment. National guidelines have grown more conservative over the past decades in management, recommending watchful waiting and observation in older men with low to intermediate risk disease. Among higher risk patients, prostatectomy (robotic is preferred) and/or external beam radiotherapy is the most common interventions, followed by ADT maintenance. Following progression on androgen deprivation therapy (ADT) (known as castration-resistance), next generation endocrine therapies like enzalutamide, often in combination with cytotoxic agent docetaxel, are standard of care. Other promising treatments include Radium-223 for bone metastases, pembrolizumab for programmed death ligand-1 (PDL1) and microsatellite instability (MSI) high disease, and poly ADP ribose polymerase (PARP) inhibitors for those with mutations in homologous recombination (most commonly BRCA2). View Full-Text
Keywords: prostate cancer; epidemiology; etiology; incidence; mortality; survival; risk factors; prevention; staging; treatment prostate cancer; epidemiology; etiology; incidence; mortality; survival; risk factors; prevention; staging; treatment
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Barsouk, A.; Padala, S.A.; Vakiti, A.; Mohammed, A.; Saginala, K.; Thandra, K.C.; Rawla, P.; Barsouk, A. Epidemiology, Staging and Management of Prostate Cancer. Med Sci (Basel) 2020, 8, 28.

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