Prostate Cancer Screening

Screening

Screening considerations

Age-specific recommendations

Prevention

PSA

Elevated PSA differential

PSA density

Probability of cancer diagnosis based on pre-biopsy PSA and DRE, from Campbell's

Prostate Biopsy and MRI

Prostate MRI

Patient optimization

Biopsy recommendations

Biopsy risks

Specific biopsy findings

TNM classification, from NCCN guidelines

TNM staging, from NCCN guidelines

Risk Classification and Genetic Testing

Risk Group Grade Group Clinical Stage PSA # Cores Positive % Core Involvement PSA Density Further Workup Treatment Recommendations Metastatic risk on surveillance
Very Low GG1 cT1-T2a < 10 < 1/3 < 50% < 0.15 none Active Surveillance < 1% @ 10-15yrs
Low - Active Surveillance
(unless high risk for progression)
~3% @ 10-15yrs
Intermediate Favorable GG1
GG2
cT2b-c 10-20
<10
* RALP +/- PLND
XRT +/- ADT
> 10-20% @ 15yrs
Intermediate Unfavorable GG2
GG3
cT2b-c 10-20
< 20
* RALP + PLND
XRT w/o ADT
High GG4-5 cT3-T4 > 20 CT +/- MR
bone scan
Consider genetic testing
RALP + PLND
XRT + ADT
ADT only (palliative option)

*Indications/Notes for Further Staging after Diagnosis

Genetic testing (from Weider's 6th edition)

References: