Screening by lower urinary tract symptoms vs asymptomatic prostate‐specific antigen levels leading to radical prostatectomy in Danish men: tumour characteristics and treatment outcome

Abstract

OBJECTIVE To compare the tumour characteristics and treatment outcome in men undergoing radical prostatectomy (RP) for prostate cancer diagnosed with or with no lower urinary tract symptoms (LUTS). PATIENTS AND METHODS In Denmark, prostate‐specific antigen (PSA) testing is recommended only in men with a family history of prostate cancer, or those with LUTS that could be caused by prostate cancer. However, increasingly many men undergoing RP are asymptomatic and are diagnosed as a result of unsystematic PSA screening. Data were collected prospectively from The Aarhus PC‐project, comprising 585 consecutive Danish men treated with RP between 1997 and 2008 at Aarhus University Hospital; of these, 47 had a family history of prostate cancer and were therefore excluded. RESULTS In all, 188 (35%) patients stated being asymptomatic at the diagnosis of cancer, while LUTS led to the diagnosis in 350 (65%). Except for tumour grade after RP there were no significant differences between these subpopulations in tumour characteristics and treatment outcome. Unexpectedly, the Gleason score of the RP specimen was a statistically significant prognostic indicator (P = 0.002) in favour of symptomatic patients. CONCLUSION This study showed no association between LUTS and tumour characteristics or treatment outcome between symptomatic and asymptomatic patients undergoing RP. The Gleason score at RP and thereby the long‐term prognosis in asymptomatic patients seems to be worse than in patients with LUTS.

Variation in general practice prostate-specific antigen testing and prostate cancer outcomes: An ecological study

“…Our study was limited by a lack of important clinical information about the indication for testing but previous studies find that opportunistic screening in Denmark is ubiquitous even though guidelines advice otherwise . Another limitation was that we had only practice identification numbers.…”

“…Our study was limited by a lack of important clinical information about the indication for testing but previous studies find that opportunistic screening in Denmark is ubiquitous even though guidelines advice otherwise. 31 Another limitation was that we had only practice identification numbers. PSA test rates from partnership practices are a mix of two or more general practitioners, but our results were consistent when looking only at single-handed practices.…”

Baseline prostate-specific antigen measurements and subsequent prostate cancer risk in the Danish Diet, Cancer and Health cohort

“…Nevertheless, increased non-systematic use of PSA during the past decade has led to a marked rise in the incidence of prostate cancer also in Denmark 26 . A recent study showed that 35% of patients treated by radical prostatectomy in Denmark between 1997 and 2008 had been referred without prostate-related symptoms 27 , and in a Swedish study 28% of prostate cancer cases diagnosed in 2005 were based on PSA testing during health examinations 28 . An impact of opportunistic screening should therefore also be considered in our study.…”

Are Men Who Undergo Radical Prostatectomy with Lower Urinary Tract Symptoms at an Increased Risk for Aggressive Prostate Cancer?

“…In a 2004 telephone survey of over 700 Korean men older than 50 years in a small city, approximately 15% had been screened for PCa during the previous 2 years (unpublished data), a much lower rate than the 75% reported for men in the United States [16]. In view of the growing proportion of asymptomatic PCa, we suggest that PSA screening is needed not only in men with LUTS that could be caused by PCa, but also in men who are asymptomatic at baseline [17,18]. …”