Prostate cancer is the second most common cancer in US men. Guidelines for screening vary, underscoring the need to engage patients in shared decision-making and counsel them about potential benefits and harms. When screening is undertaken, it is based on the prostate-specific antigen test, with digital rectal examination used selectively as an adjunct. Men with an abnormal prostate-specific antigen level should have a repeat test within a few months, before proceeding to biomarker testing, referral to urology, biopsy, and potentially imaging. Patients with newly diagnosed prostate cancer should be risk-stratified using clinical tumor (T) stage as determined by digital rectal examination, International Society of Urological Pathology grade group (Gleason score), prostate-specific antigen level, and tumor volume on biopsy. Treatment options vary by risk. Active surveillance is recommended for patients with low-risk disease, typically those with grade group 1/Gleason score of 6 (3 + 3). For patients with favorable intermediate-risk prostate cancer, treatment options are active surveillance, radiation therapy, or radical prostatectomy. For patients with unfavorable intermediate- or high-risk prostate cancer and estimated life expectancy greater than 10 years, options are radical prostatectomy or radiation therapy plus androgen deprivation therapy. For patients with prostate-specific antigen levels greater than 40 ng/dL, a Gleason score of 9 or higher, or locally advanced prostate cancer, treatment with radiation therapy and androgen deprivation therapy can additionally include concurrent abiraterone plus prednisone for 2 years. Focal ablation is also an option for some patients. Prognosis varies by disease features; men with low-risk prostate cancer are much more likely to die from other causes, whereas those with distant metastases have a 5-year relative survival rate of 38.3%.
Saffold J. Common Male Genitourinary Issues: Prostate Cancer Screening and Treatment. FP Essent. 2026;567:29-35.
Case 4. ZA is a White 48-year-old patient with a history of hypertension, prediabetes, and generalized anxiety disorder who presents for his annual health maintenanxxxxce examination. His father was diagnosed with prostate cancer with a Gleason score of 3 + 4 = 7 at age 73 years, and his brother was diagnosed with prostate cancer with a Gleason score of 3 + 3 = 6 at age 66 years. Both underwent treatment and are living without evidence of metastatic disease. He asks about his risks of developing prostate cancer and when he should start screening.
Epidemiology and Risk Factors
After skin cancer, prostate cancer is the most common cancer in men in the United States.1 In 2026, there will be more than 333,000 new cases among all ages nationally.2 Prostate cancer is the second leading cause of cancer deaths in men, although most men do not die from prostate cancer because of advances in early detection and treatment.2,3 One in 8 men will receive a prostate cancer diagnosis in their lifetime, while 1 in 44 men will die from the disease.2 Worldwide, 1 in every 14 cancers diagnosed in men is prostate cancer.4 This number is expected to double by 2040 because of longer life expectancy and population growth.4
Diagnosis later in life may be partially attributable to the slow-growing nature of prostate cancer, as autopsy studies have revealed that 20% of men ages 50 to 59 years who died of other causes had the disease.5 Prostate cancer is rarely diagnosed before age 40 years, and 6 out of 10 men receive the diagnosis after age 65 years.1 Mortality increases with age; more than two-thirds of men who die from prostate cancer are older than 75 years.5 Along with advancing age, West African ancestry and family history (an affected first-degree relative, especially if the cancer is diagnosed before age 60 years) are known risk factors.4
Read the full edition
Get immediate access, anytime, anywhere.
Choose a single edition, 1-year or 2-year full-access subscription.
Earn 4 CME credits for this edition.
