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Review
June 27, 2017

The Diagnosis and Treatment of Prostate CancerA Review

Author Affiliations
  • 1Department of Urology, David Geffen School of Medicine, University of California, Los Angeles
  • 2Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
  • 3School of Nursing, University of California, Los Angeles
  • 4Department of Urology, University of North Carolina, Chapel Hill
JAMA. 2017;317(24):2532-2542. doi:10.1001/jama.2017.7248
Key Points

Question  What are the optimal methods for the diagnosis and treatment of prostate cancer based on current evidence?

Findings  Improved risk classification methods, imaging techniques, and biomarkers have improved the ability to provide prognostic information to patients with prostate cancer. For the treatment of prostate cancer, monitoring for disease progression followed by local therapy is an accepted strategy for some men. Surgery and radiation techniques continue to evolve as treatment-related adverse effects are better defined. Median survival also has improved for men with metastatic disease and is now 5 years, due to the early administration of docetaxel and new drugs such as abiraterone, enzalutamide, and other agents.

Meaning  With recent advances, prostate cancer can be accurately characterized and more optimally managed according to tumor biology, patient preferences, and survivorship goals.

Abstract

Importance  Prostate cancer is the most common cancer diagnosis made in men with more than 160 000 new cases each year in the United States. Although it often has an indolent course, prostate cancer remains the third-leading cause of cancer death in men.

Observations  When prostate cancer is suspected, tissue biopsy remains the standard of care for diagnosis. However, the identification and characterization of the disease have become increasingly precise through improved risk stratification and advances in magnetic resonance and functional imaging, as well as from the emergence of biomarkers. Multiple management options now exist for men diagnosed with prostate cancer. Active surveillance (the serial monitoring for disease progression with the intent to cure) appears to be safe and has become the preferred approach for men with less-aggressive prostate cancer, particularly those with a prostate-specific antigen level of less than 10 ng/mL and Gleason score 3 + 3 tumors. Surgery and radiation continue to be curative treatments for localized disease but have adverse effects such as urinary symptoms and sexual dysfunction that can negatively affect quality of life. For metastatic disease, chemotherapy as initial treatment now appears to extend survival compared with androgen deprivation therapy alone. New vaccines, hormonal therapeutics, and bone-targeting agents have demonstrated efficacy in men with metastatic prostate cancer resistant to traditional hormonal therapy.

Conclusions and Relevance  Advances in the diagnosis and treatment of prostate cancer have improved the ability to stratify patients by risk and allowed clinicians to recommend therapy based on cancer prognosis and patient preference. Initial treatment with chemotherapy can improve survival compared with androgen deprivation therapy. Abiraterone, enzalutamide, and other agents can improve outcomes in men with metastatic prostate cancer resistant to traditional hormonal therapy.

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