Summary
This narrative review in JAMA synthesises current knowledge on prostate cancer as the leading nonskin malignancy in US men, highlighting epidemiological burden, genetic and demographic risk factors, and contemporary management approaches. The paper emphasises risk-stratified decision-making in screening and treatment, noting that approximately 75% of men present with localised disease (approaching 100% 5-year survival), whilst 10% have distant metastases at diagnosis (37% 5-year survival). Current therapeutic options range from active surveillance for lower-risk patients to radical prostatectomy, radiation, or androgen deprivation therapy depending on tumour characteristics and life expectancy.
UK applicability
The epidemiological and genetic findings are broadly applicable to UK populations, though absolute incidence rates may differ. UK prostate cancer management aligns with the shared decision-making approach for PSA screening and risk-stratified treatment, though specific thresholds and treatment protocols are guided by NICE guidance and may vary from US practice.
Key measures
Prostate cancer incidence rates (new cases and deaths in 2024 US; global cases and deaths in 2022), median age at diagnosis, genetic contribution to risk, annual incidence rates by race (173.0 per 100,000 Black men vs 97.1 per 100,000 White men), 5-year survival rates (localised: ~100%; metastatic: 37%), proportion with localised disease at diagnosis (75%), proportion with nodal metastases at presentation (14%), proportion with distant metastases (10%)
Outcomes reported
The paper reports epidemiological data on prostate cancer incidence and mortality in the US and globally, describes risk stratification approaches, and summarises current treatment paradigms including active surveillance, radiation, prostatectomy, and androgen deprivation therapy for metastatic disease.
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