ambossIconambossIcon

Prostate cancer

Last updated: December 14, 2023

Summarytoggle arrow icon

Prostate cancer is one of the most common cancers that affect men, especially those > 50 years of age. Typically, prostate cancer has an indolent course and is usually discovered while still localized in the prostate. This allows many patients to undergo monitoring for progression rather than active treatment, preventing unnecessary treatment-related adverse effects. Prostate cancer is typically diagnosed and monitored using prostate-specific antigen (PSA) testing, multiparametric MRI (mpMRI), and guided biopsy. Once the decision to treat has been made, therapeutic options include radical prostatectomy, radiation therapy, androgen deprivation therapy (ADT), and chemotherapy. Since all treatment options may adversely affect the patient's quality of life, shared decision-making with the patient is strongly encouraged in all current guidelines. Symptomatic management may be preferable in patients with significant comorbidities or limited life expectancy, as further treatment is unlikely to be life-prolonging.

Epidemiologytoggle arrow icon

  • Incidence: following skin cancer (i.e., melanoma and nonmelanoma combined) most common cancer in men in the US [1]
  • Mortality: in 2020, second leading cause of cancer deaths in men in the US (after lung cancer)

Epidemiological data refers to the US, unless otherwise specified.

Risk factorstoggle arrow icon

  • Advanced age (> 50 years) [1][2]
  • Family history
  • African-American descent
  • Genetic disposition (e.g., BRCA2, Lynch syndrome)
  • Dietary factors: high intake of saturated fat, well-done meats, and calcium

Advanced age is the main risk factor for prostate cancer. Sexual activity and benign prostatic hyperplasia (BPH) are not associated with prostate cancer.

References: [3][4]

Clinical featurestoggle arrow icon

Symptoms

Digital rectal examination (DRE) [6][7][8]

A DRE should be performed in individuals with elevated serum PSA levels; and as part of the comprehensive evaluation of male LUTS. DRE has a low positive predictive value for detecting prostate cancer and should not be performed as the sole screening modality.

  • May be normal; in early disease or if the cancer is located in areas of the gland that are not palpable on DRE [9]
  • Features suggestive of prostate cancer include:
    • Localized indurated nodules on an otherwise smooth surface
    • Prostatomegaly, lobar asymmetry, obliteration of the sulcus
    • Hard nontender nodules

Most prostate cancers are located in the peripheral zone (posterior lobe) of the prostate. In contrast, BPH occurs in the transitional zone of the prostate.

Even patients with advanced prostate cancer may have a normal DRE; if clinical suspicion is high, continue diagnostic evaluation for prostate cancer!

Diagnosticstoggle arrow icon

Approach

The following content is related to diagnosing prostate cancer in symptomatic patients or those with a positive screening test. Screening for prostate cancer in asymptomatic individuals is detailed separately.

Prostate-specific antigen (PSA) levels

PSA is a serine protease produced only in the prostate gland and, therefore, is an organ-specific marker. It is not cancer-specific however, as levels may also be elevated in benign conditions. [10]

A PSA level ≤ 4 ng/mL does not exclude prostate cancer!

5-alpha reductase inhibitors (5-ARIs) can suppress PSA production, resulting in spuriously low PSA levels. This should be taken into consideration in patients on long-term 5-ARIs (e.g., for BPH). [15][16]

Inflammation, manipulation of the prostate, and other malignant and benign prostate diseases may lead to a false-positive PSA result!

Urinalysis [17][18]

Initial imaging

Prostate biopsy

Gleason score and grade groups are used to grade the metastatic potential of prostate adenocarcinoma based on gland-forming differentiation.

Evaluation of tumor extent [21][22][33]

mpMRI is the preferred method for detecting local tumor extent (including recurrent prostate cancer) and PET-CT is preferred to evaluate for metastatic disease. [34][35]Skeletal metastases are the most common nonnodal sites of metastasis in prostate cancer. Vertebral metastases commonly occur due to the spread of malignant cells through the Batson vertebral venous system. Skeletal metastases are predominantly osteoblastic but osteolytic metastases can also occur.

Stagingtoggle arrow icon

The TNM staging system is based on American Joint Committee on Cancer recommendations (see “Grading and staging” in “General oncology”). Broadly, prostate cancer is divided into the following clinical stages. [21][37][38]

Managementtoggle arrow icon

Approach [21][33]

Management options for prostate cancer depend on the cancer stage, presence of high-risk features, and the patient's life expectancy. The impact of potential adverse effects of treatment on quality of life should be discussed with the patient prior to treatment initiation.

Watchful waiting [21]

  • Indications: recommended approach if all of the following apply
    • Limited life expectancy (≤ 5 years)
    • Slow-growing tumor (i.e., low-risk or intermediate-risk localized tumors)
    • Asymptomatic or minimal symptoms
  • Method
    • Regular monitoring with scheduled DRE and serum PSA levels (less intensive follow-up than active surveillance).
    • Initiate definitive management according to cancer stage only when symptoms occur.

Active surveillance [21][40]

Androgen deprivation [33][41]

Androgen deprivation therapy (ADT)

Androgen synthesis inhibitors and androgen receptor antagonists [42]

Initiate prophylaxis against treatment-induced osteoporosis and fractures in all patients on androgen deprivation and/or glucocorticoids.

First-generation antiandrogens (flutamide and bicalutamide) are used only for the short-term management of a testosterone flare. [43]

Radiation therapy [21][44]

Radical prostatectomy [21]

Radical prostatectomy involves the removal of the vas deferens, resulting in infertility.

Chemotherapy [33]

Management of bone health [48][49][50]

Prostate cancer patients are at an increased risk of skeletal features due to osteoporosis (treatment-induced and age-related) and bone metastases. [33]

Prophylaxis against treatment-induced osteoporosis and fractures

Management of skeletal events [51]

Patients with known vertebral metastatic disease and new neurological symptoms must have an urgent MRI to rule out spinal cord compression.

Follow-uptoggle arrow icon

  • Monitor serum total PSA levels. [52]
    • Every 6 months for the first 5 years, then annually for patients who have had definitive local therapy
    • Every 3–6 months for patients on ADT
  • Consider assessing PSA velocity (PSA doubling time); a significant rise or short doubling time suggests a recurrence. [11]
  • Arrange further studies for patients with abnormal PSA values.
  • Annual DRE: to monitor for prostate cancer recurrence and rectal cancer [46]

Screeningtoggle arrow icon

General principles [53]

Given the indolent nature of prostate cancer and the significant potential for treatment-related decline in quality of life, patients should be educated on the risks and benefits of participating in screening and undergoing treatment if cancer is detected. For patients with a limited life expectancy, neither screening nor treatment may be appropriate. [21][54]

  • PSA screening is controversial as it has:
    • A high false-positive rate [53]
    • A high detection rate of clinically insignificant cancers (leading to overdiagnosis) [53]
    • Minimal or no effect on prostate cancer-related mortality. [55][56][57]
  • Patient harm may occur as a result of testing and/or treatment initiated by a positive PSA screening test.

Because of the low benefit and potential risk associated with PSA screening, patients should be involved in the decision to screen for prostate cancer. [6]

Screening recommendations [54][58]

  • Recommendations for screening are based on age and life expectancy and differ between the USPSTF and AUA. [54][58]
    • USPSTF: Offer screening to all individuals between 55 and 69 years.
    • AUA
  • Screening is not recommended for patients with a life expectancy < 10 years. [58]

Screening modalities [6][58]

Prognosistoggle arrow icon

  • The most important prognostic indicator for prostate cancer is the histological grade (i.e., grade group or Gleason score). [38]
  • Broadly, patients with cancer confined to the prostate and pretreatment PSA levels < 10 ng/mL have a favorable prognosis. [21][61]
Grade groups for prostate cancer [31][62]
Grade group

Gleason score [32]

5-year survival after radical prostatectomy
1 ≤ 6 96%
2 3 + 4 = 7 88%
3 4 + 3 = 7 63%
4 4 + 4 = 8 48%
5 9 or 10 26%

Differential diagnosestoggle arrow icon

The differential diagnoses listed here are not exhaustive.

Related One-Minute Telegramtoggle arrow icon

Interested in the newest medical research, distilled to just one minute? Sign up for the One-Minute Telegram in the “Tips and links” below.

Referencestoggle arrow icon

  1. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline (2017). https://www.auanet.org/guidelines/guidelines/prostate-cancer-clinically-localized-guideline. Updated: January 1, 2017. Accessed: May 5, 2021.
  2. Advanced Prostate Cancer: AUA/ASTRO/SUO Guideline. https://web.archive.org/web/20210702115211/https://www.auanet.org/guidelines/guidelines/advanced-prostate-cancer. Updated: January 1, 2021. Accessed: July 2, 2021.
  3. Chen RC, Rumble RB, Loblaw DA, et al. Active Surveillance for the Management of Localized Prostate Cancer (Cancer Care Ontario Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement. J Clin Oncol. 2016; 34 (18): p.2182-2190.doi: 10.1200/jco.2015.65.7759 . | Open in Read by QxMD
  4. Initial Treatment of Prostate Cancer, by Stage. https://www.cancer.org/cancer/prostate-cancer/treating/by-stage.html. Updated: March 11, 2016. Accessed: February 15, 2017.
  5. Sharifi N. Androgen Deprivation Therapy for Prostate Cancer. JAMA. 2005; 294 (2): p.238.doi: 10.1001/jama.294.2.238 . | Open in Read by QxMD
  6. Lowrance WT, Breau RH, Chou R, et al. Advanced Prostate Cancer: AUA/ASTRO/SUO Guideline PART I. J Urol. 2021; 205 (1): p.14-21.doi: 10.1097/ju.0000000000001375 . | Open in Read by QxMD
  7. Pisansky TM, Thompson IM, Valicenti RK, D’Amico AV, Selvarajah S. Adjuvant and Salvage Radiotherapy after Prostatectomy: ASTRO/AUA Guideline Amendment 2018-2019. J Urol. 2019; 202 (3): p.533-538.doi: 10.1097/ju.0000000000000295 . | Open in Read by QxMD
  8. National Institute for Health and Care Excellence (NICE) Guidance: Prostate cancer: diagnosis and management. https://www.nice.org.uk/guidance/ng131. Updated: May 9, 2019. Accessed: May 5, 2021.
  9. Baxter NN, Tepper JE, Durham SB, Rothenberger DA, Virnig BA. Increased risk of rectal cancer after prostate radiation: A population-based study. Gastroenterology. 2005; 128 (4): p.819-824.doi: 10.1053/j.gastro.2004.12.038 . | Open in Read by QxMD
  10. Stephenson AJ, Eastham JA. Role of Salvage Radical Prostatectomy for Recurrent Prostate Cancer After Radiation Therapy. J Clin Oncol. 2005; 23 (32): p.8198-8203.doi: 10.1200/jco.2005.03.1468 . | Open in Read by QxMD
  11. Lowrance WT, Breau RH, Chou R, et al. Advanced Prostate Cancer: AUA/ASTRO/SUO Guideline PART II. J Urol. 2021; 205 (1): p.22-29.doi: 10.1097/ju.0000000000001376 . | Open in Read by QxMD
  12. Hussain A, Tripathi A, Pieczonka C, et al. Bone health effects of androgen-deprivation therapy and androgen receptor inhibitors in patients with nonmetastatic castration-resistant prostate cancer. Prostate Cancer Prostatic Dis. 2020; 24 (2): p.290-300.doi: 10.1038/s41391-020-00296-y . | Open in Read by QxMD
  13. Brown JE, Handforth C, Compston JE, et al. Guidance for the assessment and management of prostate cancer treatment-induced bone loss. A consensus position statement from an expert group. Journal of Bone Oncology. 2020; 25: p.100311.doi: 10.1016/j.jbo.2020.100311 . | Open in Read by QxMD
  14. Parker C, Castro E, Fizazi K, et al. Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann of Oncol. 2020; 31 (9): p.1119-1134.doi: 10.1016/j.annonc.2020.06.011 . | Open in Read by QxMD
  15. Key Statistics for Prostate Cancer. https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html. Updated: January 5, 2017. Accessed: March 5, 2017.
  16. Jahn JL, Giovannucci EL, Stampfer MJ. The high prevalence of undiagnosed prostate cancer at autopsy: implications for epidemiology and treatment of prostate cancer in the Prostate-specific Antigen-era. International Journal of Cancer. 2015; 137 (12): p.2795-2802.doi: 10.1002/ijc.29408 . | Open in Read by QxMD
  17. Kasper DL, Fauci AS, Hauser SL, Longo DL, Lameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. McGraw-Hill Education ; 2015
  18. Prostate Cancer Risk Factors. https://www.cancer.org/cancer/prostate-cancer/causes-risks-prevention/risk-factors.html. Updated: June 9, 2020. Accessed: November 9, 2020.
  19. Philip J, Mathew J. Penile metastasis of prostatic adenocarcinoma: Report of two cases and review of literature. World J Surg Oncol. 2003; 1 (1): p.16.doi: 10.1186/1477-7819-1-16 . | Open in Read by QxMD
  20. Stevermer JJ, Fink KS. Counseling Patients About Prostate Cancer Screening. Am Fam Physician. 2018; 98 (8): p.478-483.
  21. 2018 review of the 2013 AUA guideline on the early detection of prostate cancer. https://web.archive.org/web/20210604081830/https://www.auanet.org/guidelines/guidelines/prostate-cancer-early-detection-guideline. Updated: January 1, 2018. Accessed: June 4, 2021.
  22. Streicher J, Meyerson BL, Karivedu V, Sidana A. A review of optimal prostate biopsy: indications and techniques. Therapeutic advances in urology. ; 11: p.1756287219870074.doi: 10.1177/1756287219870074 . | Open in Read by QxMD
  23. Wernert N. The peripheral zone of the prostate is more prone to tumor development than the transitional zone: Is the ETS family the key?. Molecular Medicine Reports. 2011.doi: 10.3892/mmr.2011.647 . | Open in Read by QxMD
  24. Saini S. PSA and beyond: alternative prostate cancer biomarkers. Cell Oncol (Dordr). 2016; 39 (2): p.97-106.doi: 10.1007/s13402-016-0268-6 . | Open in Read by QxMD
  25. Javaeed A, Ghauri SK, Ibrahim A, Doheim MF. Prostate-specific antigen velocity in diagnosis and prognosis of prostate cancer - a systematic review. Oncology Reviews. 2020; 14 (1).doi: 10.4081/oncol.2020.449 . | Open in Read by QxMD
  26. Gretzer MB, Partin AW. PSA Levels and the Probability of Prostate Cancer on Biopsy. Eur Urol. 2002; 1 (6): p.21-27.doi: 10.1016/s1569-9056(02)00053-2 . | Open in Read by QxMD
  27. Carter HB. Prostate cancers in men with low PSA levels--must we find them?. N Engl J Med. 2004; 350 (22): p.2292-4.doi: 10.1056/NEJMe048003 . | Open in Read by QxMD
  28. Lechevallier E, Eghazarian C, Ortega J-C, Roux F, Coulange C. Effect of digital rectal examination on serum complexed and free prostate-specific antigen and percentage of free prostate-specific antigen. Urology. 1999; 54 (5): p.857-861.doi: 10.1016/s0090-4295(99)00239-3 . | Open in Read by QxMD
  29. Sarkar RR, Parsons JK, Bryant AK, et al. Association of Treatment With 5α-Reductase Inhibitors With Time to Diagnosis and Mortality in Prostate Cancer. JAMA internal medicine. 2019; 179 (6): p.812-819.doi: 10.1001/jamainternmed.2019.0280 . | Open in Read by QxMD
  30. Gratzke C, Bachmann A, Descazeaud A, et al. EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction. Eur Urol. 2015; 67 (6): p.1099-1109.doi: 10.1016/j.eururo.2014.12.038 . | Open in Read by QxMD
  31. Abdelmoteleb H, Jefferies ER, Drake MJ. Assessment and management of male lower urinary tract symptoms (LUTS). International Journal of Surgery. 2016; 25: p.164-171.doi: 10.1016/j.ijsu.2015.11.043 . | Open in Read by QxMD
  32. Coker TJ, Dierfeldt DM. Acute bacterial prostatitis: diagnosis and management. Am Fam Physician. 2016; 93 (2): p.114-120.
  33. Standard Operating Procedure for Multiparametric Magnetic Resonance Imaging in the Diagnosis, Staging and Management of Prostate Cancer 2019. https://www.auanet.org/guidelines/guidelines/mri-of-the-prostate-sop. Updated: September 1, 2019. Accessed: October 15, 2021.
  34. Bjurlin MA, Carroll PR, Eggener S, et al. Update of the Standard Operating Procedure on the Use of Multiparametric Magnetic Resonance Imaging for the Diagnosis, Staging and Management of Prostate Cancer. J Urol. 2020; 203 (4): p.706-712.doi: 10.1097/JU.0000000000000617 . | Open in Read by QxMD
  35. Coakley FV, Oto A, Alexander LF, et al. ACR Appropriateness Criteria ® Prostate Cancer—Pretreatment Detection, Surveillance, and Staging. Journal of the American College of Radiology. 2017; 14 (5): p.S245-S257.doi: 10.1016/j.jacr.2017.02.026 . | Open in Read by QxMD
  36. Harvey CJ, Pilcher J, Richenberg J, Patel U, Frauscher F. Applications of transrectal ultrasound in prostate cancer. Br J Radiol. 2012; 85 Spec No 1: p.S3-17.doi: 10.1259/bjr/56357549 . | Open in Read by QxMD
  37. Wasson JH, Bubolz TA, Yao GL, Barry MJ. Prostate biopsies in men with limited life expectancy. Eff Clin Pract. ; 5 (3): p.137-42.
  38. Walz J, Haese A, Scattoni V, et al. Percent free prostate-specific antigen (PSA) is an accurate predictor of prostate cancer risk in men with serum PSA 2.5 ng/mL and lower. Cancer. 2008; 113 (10): p.2695-2703.doi: 10.1002/cncr.23885 . | Open in Read by QxMD
  39. Aminsharifi A, Howard L, Wu Y, et al. Prostate Specific Antigen Density as a Predictor of Clinically Significant Prostate Cancer When the Prostate Specific Antigen is in the Diagnostic Gray Zone: Defining the Optimum Cutoff Point Stratified by Race and Body Mass Index. J Urol. 2018; 200 (4): p.758-766.doi: 10.1016/j.juro.2018.05.016 . | Open in Read by QxMD
  40. Ploussard G, Haese A, Van Poppel H, et al. The prostate cancer gene 3 (PCA3) urine test in men with previous negative biopsies: does free-to-total prostate-specific antigen ratio influence the performance of the PCA3 score in predicting positive biopsies?. BJU Int. 2010; 106 (8): p.1143-1147.doi: 10.1111/j.1464-410x.2010.09286.x . | Open in Read by QxMD
  41. Chang DTS, Challacombe B, Lawrentschuk N. Transperineal biopsy of the prostate—is this the future?. Nature Reviews Urology. 2013; 10 (12): p.690-702.doi: 10.1038/nrurol.2013.195 . | Open in Read by QxMD
  42. Islam M, Da Silva RD, Gustafson D, Nogueira L, Clark N, Kim F. A Comparison of Infectious Outcomes Between In-office Transperineal Prostate Biopsies Without Antibiotic Prophylaxis and Transrectal Prostate Biopsies. J Urol. 2020; 203 (Supplement 4).doi: 10.1097/ju.0000000000000853.06 . | Open in Read by QxMD
  43. Prostate cancer types. https://www.cancercenter.com/cancer-types/prostate-cancer/types. Updated: November 5, 2020. Accessed: November 6, 2020.
  44. Gordetsky J, Epstein J. Grading of prostatic adenocarcinoma: current state and prognostic implications. Diagn Pathol. 2016; 11 (1).doi: 10.1186/s13000-016-0478-2 . | Open in Read by QxMD
  45. Prostatic Adenocarcinoma: Gleason Grading (Modified Grading by ISUP). https://web.archive.org/web/20210705111204/https://www.auanet.org/education/auauniversity/education-products-and-resources/pathology-for-urologists/prostate/adenocarcinoma/prostatic-adenocarcinoma-gleason-grading-%28modified-grading-by-isup%29. . Accessed: July 5, 2021.
  46. Panebianco V, Barchetti F, Musio D, et al. Advanced Imaging for the Early Diagnosis of Local Recurrence Prostate Cancer after Radical Prostatectomy. Biomed Res Int. 2014; 2014: p.1-12.doi: 10.1155/2014/827265 . | Open in Read by QxMD
  47. Bhargava P, Ravizzini G, Chapin BF, Kundra V. Imaging Biochemical Recurrence After Prostatectomy: Where Are We Headed?. AJR Am J Roentgenol. 2020; 214 (6): p.1248-1258.doi: 10.2214/ajr.19.21905 . | Open in Read by QxMD
  48. Poulsen MH, Petersen H, Høilund-Carlsen PF, et al. Spine metastases in prostate cancer: comparison of technetium-99m-MDP whole-body bone scintigraphy, [18F]choline positron emission tomography(PET)/computed tomography (CT) and [18F]NaF PET/CT. BJU Int. 2014; 114 (6): p.818-823.doi: 10.1111/bju.12599 . | Open in Read by QxMD
  49. Fenton JJ, Weyrich MS, Durbin S, Liu Y, Bang H, Melnikow J. Prostate-Specific Antigen–Based Screening for Prostate Cancer. JAMA. 2018; 319 (18): p.1914.doi: 10.1001/jama.2018.3712 . | Open in Read by QxMD
  50. Grossman DC, Curry SJ, et al. Screening for Prostate Cancer. JAMA. 2018; 319 (18): p.1901.doi: 10.1001/jama.2018.3710 . | Open in Read by QxMD
  51. Schröder FH, Hugosson J, Roobol MJ, et al. Screening and Prostate-Cancer Mortality in a Randomized European Study. N Engl J Med. 2009; 360 (13): p.1320-1328.doi: 10.1056/nejmoa0810084 . | Open in Read by QxMD
  52. Martin RM, Donovan JL, Turner EL, et al. Effect of a Low-Intensity PSA-Based Screening Intervention on Prostate Cancer Mortality. JAMA. 2018; 319 (9): p.883.doi: 10.1001/jama.2018.0154 . | Open in Read by QxMD
  53. Pinsky PF, Prorok PC, Yu K, et al. Extended mortality results for prostate cancer screening in the PLCO trial with median follow-up of 15 years. Cancer. 2017; 123 (4): p.592-599.doi: 10.1002/cncr.30474 . | Open in Read by QxMD
  54. Wei JT, Barocas D, Carlsson S, et al. Early Detection of Prostate Cancer: AUA/SUO Guideline Part I: Prostate Cancer Screening. J Urol. 2023; 210 (1): p.46-53.doi: 10.1097/ju.0000000000003491 . | Open in Read by QxMD
  55. Etzioni RD, Howlader N, Shaw PA, et al. Long-term effects of finasteride on prostate specific antigen levels: results from the prostate cancer prevention trial. J Urol. 2005; 174 (3): p.877-881.doi: 10.1097/01.ju.0000169255.64518.fb . | Open in Read by QxMD
  56. Halpern JA, Oromendia C, Shoag JE, et al. Use of Digital Rectal Examination as an Adjunct to Prostate Specific Antigen in the Detection of Clinically Significant Prostate Cancer. J Urol. 2018; 199 (4): p.947-953.doi: 10.1016/j.juro.2017.10.021 . | Open in Read by QxMD
  57. Skolarus TA, Wolf AMD, Erb NL, et al. American Cancer Society prostate cancer survivorship care guidelines. CA Cancer J Clin. 2014; 64 (4): p.225-249.doi: 10.3322/caac.21234 . | Open in Read by QxMD
  58. Lin D. AJCC Cancer Staging Manual Eighth Edition. American College of Surgeons ; 2018
  59. Buyyounouski MK, Choyke PL, McKenney JK, et al. Prostate cancer - major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017; 67 (3): p.245-253.doi: 10.3322/caac.21391 . | Open in Read by QxMD
  60. Payne H. Management of locally advanced prostate cancer. Asian J Androl. 2009; 11 (1): p.81-7.doi: 10.1038/aja.2008.9 . | Open in Read by QxMD
  61. Frendl DM, FitzGerald G, Epstein MM, Allison JJ, Sokoloff MH, Ware JE. Predicting the 10-year risk of death from other causes in men with localized prostate cancer using patient-reported factors: Development of a tool. PLoS ONE. 2020; 15 (12): p.e0240039.doi: 10.1371/journal.pone.0240039 . | Open in Read by QxMD
  62. Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol. 2016; 40 (2): p.244-252.doi: 10.1097/pas.0000000000000530 . | Open in Read by QxMD

Icon of a lock3 free articles remaining

You have 3 free member-only articles left this month. Sign up and get unlimited access.
 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer