Adenocarcinoma of the prostate is histologically the commonest form of prostate malignancy. It is often asymptomatic until advanced or metastatic disease leads to symptoms of obstructive uropathy or bone pain respectively. Diagnosis depends upon digital rectal palpation, levels of prostate-specific antigen and prostate biopsy.
Prostate cancer ranks the fifth in the list of the common causes of death in men suffering from cancer  . The most prevalent histological form of prostate malignancy is an adenocarcinoma  . Although widespread globally, it's incidence is high among the males of African descent in the United States .
Screening tests currently help to diagnose adenocarcinoma of the prostate before the onset of symptoms . In addition, it is often asymptomatic as it grows slowly. Symptoms typically appear in advanced stages either due to urinary obstruction or metastasis. The main symptoms include increased frequency of urination, urinary hesitancy, weak urine stream, nocturia, urinary urgency, and hematuria. Renal dysfunction secondary to urinary obstruction or enlarged retroperitoneal lymph nodes may also be a presenting manifestation.
The workup of adenocarcinoma of the prostate commences with a detailed history and a digital rectal examination (DRE). Palpation of nodules or induration on DRE could indicate malignancy or prostatitis with seminal vesicle induration and restricted mobility of the prostate being suggestive of advanced prostate malignancy.
Laboratory tests like a complete blood count, renal function tests, acid phosphatase levels and prostate-specific antigen (PSA) levels are performed in all patients. PSA is a tumor marker        and high baseline levels are suggestive of a current or future likelihood of metastasis but it does not predict the risk of the disease. Elevated acid phosphatase levels are an indicator of poor prognosis although its levels could also be elevated after a prostate massage, in benign prostate hypertrophy (BPH) and some other disorders.
Confirmation of the diagnosis requires a biopsy with histology. The biopsy is typically obtained through an ultrasound directed transrectal approach. Multiple biopsies are taken from different sites and this helps to detect malignancy in patients with an elevated PSA level . An ultrasound guided transperineal biopsy is preferred in patients in whom transrectal biopsy is likely to be associated with complications . The Gleason score is used to define the histological differentiation of the tumor in the biopsy specimen  and is an indicator of tumor aggressiveness . Well-differentiated tumors usually have a score less than or equal to six; moderately differentiated tumors have a score of 7 while poorly differentiated tumors are scored 8 -10.
Imaging studies like transrectal ultrasonography (TRUS), computed tomography (CT) scan, magnetic resonance imaging (MRI) and bone scan are used to detect local and distant spread and for staging adenocarcinoma of the prostate. Indium-111 capromab pendetide scanning and reverse transcriptase - polymerase chain reaction (PCR) assays for circulating prostate cancer cells are being studied as potential tools for staging and prognosis.