What are the diseases of the prostate (prostate gland)?

From the Guidelines

Prostate diseases, including prostate cancer, should be managed based on the latest NCCN guidelines, which emphasize early detection and treatment to reduce morbidity and mortality. The management of prostate diseases includes benign prostatic hyperplasia (BPH), prostatitis, and prostate cancer. BPH is the most common, affecting older men with symptoms like frequent urination, weak stream, and incomplete emptying. Treatment options include alpha-blockers (tamsulosin 0.4mg daily) to relax muscles and 5-alpha reductase inhibitors (finasteride 5mg daily) to shrink the prostate, as recommended by various studies 1.

Prostatitis presents as pelvic pain and urinary symptoms, with bacterial forms treated using antibiotics like ciprofloxacin 500mg twice daily for 2-4 weeks. Prostate cancer often develops slowly with few early symptoms; screening involves PSA blood tests and digital rectal exams for men over 50, as outlined in the NCCN guidelines for prostate cancer early detection 1.

• Key points to consider in the management of prostate cancer include:
  • Early detection and treatment to reduce morbidity and mortality
  • Active surveillance for low-risk disease
  • Surgery (radical prostatectomy), radiation therapy, or hormone therapy (such as leuprolide injections) for localized disease
  • Systemic therapies, including androgen deprivation therapy (ADT), for advanced disease
  • Bone modifying drugs for men with bone metastases and castration-resistant prostate cancer (CRPC), as recommended by the NCCN guidelines 1

The NCCN guidelines should be followed for the management of prostate cancer, with a focus on minimizing unnecessary procedures and limiting the detection of indolent disease. Risk factors for prostate diseases include aging, family history, and lifestyle factors. Regular check-ups are essential for early detection, especially after age 50. Maintaining a healthy lifestyle with regular exercise and a diet rich in fruits and vegetables may help reduce prostate disease risk. According to the NCCN guidelines insights: prostate cancer, version 1.2021, an estimated 191,930 new cases of prostate cancer were diagnosed in the United States in 2020, accounting for 21% of new cancer cases in men 1.

The age-adjusted death rate from prostate cancer declined by 52% from 1993 to 2017, but the death rate has become stable in recent years, highlighting the need for continued efforts in early detection and treatment 1.

• Additional considerations in the management of prostate diseases include:
  • Patient and disease characteristics, such as tumor stage and grade
  • Sequential systemic therapies for men with CRPC
  • Bone health and the use of bone modifying drugs to reduce the risk of skeletal-related events
  • Quality of life and symptom management, including pain control and urinary symptoms.

From the FDA Drug Label

The symptoms associated with benign prostatic hyperplasia (BPH) are related to bladder outlet obstruction, which is comprised of two underlying components: static and dynamic. The static component is related to an increase in prostate size caused, in part, by a proliferation of smooth muscle cells in the prostatic stroma However, the severity of BPH symptoms and the degree of urethral obstruction do not correlate well with the size of the prostate.

The tamsulosin drug label discusses benign prostatic hyperplasia (BPH), a disease of the prostate, and its symptoms.

• The static component of BPH is related to an increase in prostate size.
• The dynamic component is a function of an increase in smooth muscle tone in the prostate and bladder neck. The label does not provide information on other diseases of the prostate, only BPH 2.

From the Research

Diseases of the Prostate

• Prostate cancer is a common malignancy in men, and its worldwide burden is rising 3
• Lifestyle modifications such as smoking cessation, exercise, and weight control offer opportunities to reduce the risk of developing prostate cancer 3
• Early detection of prostate cancer by prostate-specific antigen (PSA) screening is controversial, but changes in the PSA threshold, frequency of screening, and the use of other biomarkers have the potential to minimize the overdiagnosis associated with PSA screening 3

Diagnosis and Detection

• Digital rectal examination (DRE) and PSA testing are commonly used for the detection of prostate cancer 4, 5
• The combined use of DRE and PSA testing provides a more complete evaluation of the prostate gland for malignant involvement 4
• However, the diagnostic value of DRE as an independent test or as a supplementary measure to PSA for prostate cancer detection is notably low 5
• PSA response is a potential biomarker for treatment response in patients with advanced prostate cancer treated with androgen deprivation therapy plus an androgen receptor pathway inhibitor 6

Prognostic Significance

• Abnormal DRE and PSA are associated with a greater risk of clinically significant prostate cancer and prostate cancer-specific mortality 7
• PSA response following androgen deprivation therapy plus an androgen receptor pathway inhibitor therapy is significantly associated with overall survival across all metastatic and castration-resistant prostate cancer states 6
• The prognostic significance of DRE and PSA in the prostate, lung, colorectal, and ovarian cancer screening arm suggests that suspicious DRE and abnormal PSA on routine screening are independently associated with clinically significant prostate cancer and prostate cancer-specific mortality 7

Screening Strategies

• Mass screening for prostate cancer in asymptomatic men cannot be advocated until a decrease in the mortality rate is established by randomized, controlled studies 4
• The screening strategy combining DRE and PSA was not different from that of PSA alone in terms of cancer detection rate and positive predictive value 5
• It remains to be proven whether the PSA response is a surrogate for overall survival or should guide changes in clinical care 6