Prostatic acinar adenocarcinoma is a primary malignant epithelial-derived neoplasm of the prostate, which has various degrees of glandular differentiation. ¹

Advancing age, Black race, family history, environmental and lifestyle factors, and obesity are risk factors for prostate cancer. A family history of prostate cancer is associated with a 2.5-fold increase in the risk of prostate cancer. Germline gene mutations also play a significant role in the pathogenesis of prostate cancer. ¹²

Prostate cancer is the fourth most common cancer and the eighth leading cause of cancer death throughout the world. It is the most common non-skin cancer and the second common cause of cancer-related death in American men. Prostate cancer is less common in men younger than 50 years of age. However, the prevalence increases to 40% of older age groups harboring the disease in autopsy studies. The clinical incidence varies in different geographical areas with the highest incidence rate in North America, Europe, Australia, and Southern Africa, and the incidence lowest in Northern Africa and Asia. ²

Most patients with prostate cancer are asymptomatic and are diagnosed because of increased levels of prostate-specific antigen (PSA) in the serum. Symptoms of lower urinary tract obstruction including urinary hesitancy, frequency, urgency, and urinary incontinence are frequently found in large and locally advanced prostate cancer cases with or without concomitant benign prostatic hyperplasia. Other symptoms may include pain, hematuria, rectal obstruction, and hemospermia. Patients may present with bone pain and pathologic fractures because of spinal bone metastasis. ²

Laboratory findings

Serum PSA also increases with age. Most prostatic acinar adenocarcinomas produce PSA and the serum PSA levels are commonly used for the screening and detection of prostate cancer. PSA is useful in evaluating treatment response and monitoring disease progression and recurrence. PSA levels less than 10 ng/mL are usually present in patients with localized prostate cancer, while levels of PSA greater than 40 ng/mL are more often found in advanced and metastatic diseases. There is no cut-off value of PSA levels for including or excluding prostate cancer. The vast majority of men without prostate cancer have PSA values less than 4 ng/mL. Other studies including free PSA versus total PSA, PSA density, velocity, doubling time, pro-PSA, IsoPSA, have been proposed for improving the specificity. ²

Low-risk cancers (Gleason grade 6, grade group 1) are usually small and well-differentiated tumors confined to the prostate. High-risk cancers (Gleason grades 8 and 9, grade groups 4 and 5) are more often locally advanced tumors with bone or lymph node metastases. CAPRA normogram includes patient age, PSA, tumor grade (Gleason score), percentage of positive biopsies, and clinical stage and is commonly used to predict the possibility of chemical recurrence and prostate cancer-specific and overall survival. ²

Risk stratification classifies patients as very low, low, intermediate, and high risk is used as a guidance for decision of treatment. The risk stratification is based on the PSA level at diagnosis, DRE, and Gleason score of the prostate cancer. ²

1. Active surveillance

Active surveillance is appropriate for treating low-risk patients with tumor confined to the prostate, low PSA (

Patients with BRCA1, BRCA2, and ATM gene mutations can be treated with olaparib (poly-ADP-ribose polymerase (PARP) inhibitors). ²