A practical guide to prostate cancer diagnosis and management

Cleveland Clinic Journal of Medicine, 05/09/2011

Simmons MN - This review summarizes current American Urological Association (AUA) guidelines, as well as current practice patterns at the Glickman Urological and Kidney Institute of Cleveland Clinic regarding screening, diagnosis, risk assessment, treatment, and posttreatment management of prostate cancer.

  • The AUA recommends annual screening with both digital rectal examination (DRE) and prostate-specific antigen (PSA) testing starting at age 40 for all men whose life expectancy is more than 10 years.
  • If the DRE is abnormal or if the PSA level is persistently higher than 2.5 microg/L, then biopsy should be considered.
  • In low-risk cases, active surveillance may be acceptable in lieu of immediate treatment. Patient education, accurate disease assessment, and compliance with monitoring are critical considerations.
  • The most common primary treatments are active surveillance, prostatectomy, interstitial brachytherapy, external beam radiotherapy, and cryotherapy.
  • Newer ablative and focal therapies may offer an advantage in select patients; and which treatment to use is highly patient-dependent.

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