Therapeutic Areas / Prostate Cancer / Fact Sheet
Fact Sheet
Current Disease Burden
Coming Soon
Projected Disease Burden
Coming Soon
Value-for-money for Innovative Medicine
Coming Soon
Fact Sheet
Disclaimer: The SCAN2030 website is intended solely for facilitating non-profit research and development in relation to medical and healthcare related policies.

What is Prostate Cancer?

What is Prostate Cancer (PCa)?

Prostate cancer (PCa) is the most common malignant tumour affecting the urinary system. In 2020, it ranked fourth in incidence among all cancers, comprising 7.3% of all new cancer cases. Notably, PCa was the second most frequently diagnosed cancer in men globally, accounting for 14.1% of new cancer cases in males1.

Castration-Resistant Prostate Cancer (CRPC)

Castration-Resistant Prostate Cancer (CRPC) is characterised by disease progression despite androgen deprivation therapy, with serum testosterone maintained at castration levels. Disease progression can be monitored through prostate-specific antigen (PSA) testing or imaging evidence2.

Metastatic Prostate Cancer (PCa)

Metastasis occurs when cancer spreads from its original site to distant parts of the body. Metastatic PCa includes metastatic hormone-sensitive prostate cancer (mHSPC) and metastatic castration-resistant prostate cancer (mCRPC). These subtypes of metastatic PCa exhibit the characteristics of hormone sensitivity2.

Generally, CRPC is relatively late-stage of the disease.

Epidemiology

Incidence

In 2020, there were over 1,414,259 estimated new cases of PCa worldwide, with an age-standardised incidence of 37.5 per 100,000 males in higher human development index countries1.

Prevalence

5% (3-8%) prevalence at age <30 years to a prevalence of 59% (48-71%) by age >79 years3.

Mortality

PCa also significantly contributes to cancer-related deaths, with 375,304 deaths in 2020 worldwide, positioning as the fifth most common cause of cancer-related mortality in men1.

Demographic Profiles

Subclinical prostate cancer, the presence of prostate cancer with no noticeable symptoms, is common in men >50 years2.

Possible Causes And Risk Factors

Genetic Factors

Family history of malignancy, genetic mutations (e.g. BRCA1 and BRCA2) and cancer predisposition syndromes (Lynch syndrome), ethnicity and race4.

Signs And Symptoms

Lower urinary tract symptoms (LUTS)
Nocturia (frequent need to urinate at night)
Poor urinary stream
Erectile dysfunction
Visible haematuria (blood in urine)
Usually, prostate cancer are asymptomatic at early stages. Clinical signs that are possibly associated with prostate cancer include an elevated PSA on laboratory testing and an abnormal prostate finding on digital rectal examination4,5.

Diagnosis

Abnormal digital rectal exam

Initial Suspicion

Elevated PSA level
Biopsies

Definitive Diagnosis11, 12

Multi-parametric magnetic resonance imaging (mpMRI)

Standard Treatment

Low-risk Disease8
a) Watchful waiting
b) Active surveillance
c) Radical prostatectomy without pelvic lymph node dissection
d) Radiotherapy
e) Therapeutic options outside surgery or radiotherapy (focal therapy using different energic platforms)
 
Intermediate-risk Disease13
a) Watchful waiting
b) Active surveillance
c) Radical prostatectomy
d) Extended pelvic lymph node dissection
e) Radiotherapy
f) Therapeutic options outside surgery or radiotherapy
High-risk localised Disease13
a) Watchful waiting
b) Active surveillance
c) Radical prostatectomy
d) Extended pelvic lymph node dissection
e) Radiotherapeutic treatment
f) Therapeutic options outside surgery or radiotherapy
Locally-advanced Disease13
a) Radical prostatectomy
b) Extended pelvic lymph node dissection
c) Radiotherapeutic treatment
d) Therapeutic options outside surgery or radiotherapy

Factors related to Prognosis

Age and Overall Health

Younger individuals with better overall health often tolerate treatments well and may have a more favourable prognosis. However, age alone should not dictate treatment decisions, and individual circumstances should be taken into account8.

Stage of Prostate Cancer

This refers to the extent of the disease and its spread beyond the prostate gland. The most commonly used staging system is the TNM system, assessing tumour size (T), lymph node involvement (N), and the presence of metastasis (M). Generally, earlier stages (T1 or T2) have a more favourable prognosis13.

Grade of Prostate Cancer

This is determined by the Gleason score (ranges: 6-10), which evaluates the microscopic appearance of cancer cells. Lower scores indicate less aggressive tumours and a more favourable prognosis8.

Stage of Prostate Cancer

This refers to the extent of the disease and its spread beyond the prostate gland. The most commonly used staging system is the TNM system, assessing tumour size (T), lymph node involvement (N), and the presence of metastasis (M). Generally, earlier stages (T1 or T2) have a more favourable prognosis8.

Grade of Prostate Cancer

This is determined by the Gleason score (ranges: 6-10), which evaluates the microscopic appearance of cancer cells. Lower scores indicate less aggressive tumours and a more favourable prognosis8.

PSA Level

PSA is a protein produced by the prostate gland. Elevated PSA levels can indicate prostate-related conditions, including prostate cancer. Higher PSA levels may suggest a higher risk or more advanced stage of prostate cancer. However, further evaluation is required together with PSA levels to define and diagnose the stage of prostate cancer8. A faster rise in PSA levels over time may indicate more aggressive disease or potential recurrence after treatment. Monitoring Prostate-Specific Antigen Doubling Time (PSADT) can help guide treatment decisions and monitor disease progression8.

Factors

Age and Overall Health
Stage of Prostate Cancer
Grade of Prostate Cancer
Stage of Prostate Cancer
Grade of Prostate Cancer
PSA Level

Reference(s):

1Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49.

2Horwich A, Parker C, Bangma C, Kataja V. Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21 Suppl 5:v129-33.

3Bell KJ, Del Mar C, Wright G, Dickinson J, Glasziou P. Prevalence of incidental prostate cancer: A systematic review of autopsy studies. Int J Cancer. 2015;137(7):1749-57.

4Gandaglia G, Leni R, Bray F, Fleshner N, Freedland SJ, Kibel A, et al. Epidemiology and Prevention of Prostate Cancer. Eur Urol Oncol. 2021;4(6):877-92.

5Lippi G, Mattiuzzi C. Fried food and prostate cancer risk: systematic review and meta-analysis. Int J Food Sci Nutr. 2015;66(5):587-9.

6Liss MA, Al-Bayati O, Gelfond J, Goros M, Ullevig S, DiGiovanni J, et al. Higher baseline dietary fat and fatty acid intake is associated with increased risk of incident prostate cancer in the SABOR study. Prostate Cancer Prostatic Dis. 2019;22(2):244-51.

7Gacci M, Russo GI, De Nunzio C, Sebastianelli A, Salvi M, Vignozzi L, et al. Meta-analysis of metabolic syndrome and prostate cancer. Prostate Cancer Prostatic Dis. 2017;20(2):146-55.

8Lian WQ, Luo F, Song XL, Lu YJ, Zhao SC. Gonorrhea and Prostate Cancer Incidence: An Updated Meta-Analysis of 21 Epidemiologic Studies. Med Sci Monit. 2015;21:1902-10.

9Russo GI, Calogero AE, Condorelli RA, Scalia G, Morgia G, La Vignera S. Human papillomavirus and risk of prostate cancer: a systematic review and meta-analysis. Aging Male. 2020;23(2):132-8.

10Rebbeck TR, Devesa SS, Chang BL, Bunker CH, Cheng I, Cooney K, et al. Global patterns of prostate cancer incidence, aggressiveness, and mortality in men of african descent. Prostate Cancer. 2013;2013:560857.

11Schaeffer EM, Srinivas S, Adra N, An Y, Barocas D, Bitting R, et al. Prostate Cancer, Version 4.2023, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2023;21(10):1067-96.

12Horwich A, Parker C, de Reijke T, Kataja V. Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24 Suppl 6:vi106-14.

13Cornford P, van den Bergh RCN, Briers E, Van den Broeck T, Brunckhorst O, Darraugh J, et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer-2024 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2024.

This project is funded by the UGC Research Impact Fund (RIF)(reference number: R7007-22)
Copyright © 2024 Li Ka Shing Faculty of Medicine, The University of Hong Kong. All Rights Reserved.
Web Design by YSD