The potentially curable prostate cancer patient and the pathways leading to diagnosis and treatment

Abstract

The most important reason for referring patients to our specialist clinic was elevated PSA, often detected by means of opportunistic PSA screening. This study shows the effect of PSA testing in real-life practice.

Pathways to the diagnosis of prostate cancer in a British city. A population-based study

“…A much higher proportion of cancers are detected following PSA screening in the USA. From Norway, Gjengsto et al [12] reported that 53% of men had their prostatic cancer discovered by asymptomatic testing in a study conducted in a early prostate cancer clinic between January 1997 and December 2000. They identified 360 cancers in a population of :/250 000, an annual rate of 36/100 000 population.…”

“…The rate in the current UK study was similar. However, in the study of Gjengsto et al [12], patients aged /70 years or with substantial morbidity were not studied as they were not deemed suitable for the clinic in question. Even if it is assumed that approximately a quarter of cancers in men aged B/70 years bypassed that clinic because of generalized ill-health or a urological emergency, the percentage of cancers diagnosed as a result of a screening PSA test was much higher in Norway.…”

“…Only 10% of patients in a Scandinavian trial of radical prostatectomy recruited between 1989 and 1999 had been diagnosed after a screening PSA test [10]. However, in two recent Scandinavian studies [11,12] the proportion of cancers detected following a screening PSA test was reported to be higher. The first study [11] was a retrospective analysis of 1496 stage T1c tumours (non-palpable tumours detected during work-up for an elevated PSA level) in Sweden.…”

“…Asymptomatic men accounted for 32% of these cases, symptomatic men for 51% and other causes for 17%. The authors of the second study [12] from a urology clinic in Norway reported that the majority of their prostate cancer patients diagnosed between 1997 and 2000 had been asymptomatic, and were referred on the basis of an elevated PSA level alone as the result of opportunistic screening.…”

High prostate cancer mortality in Norway: Influence of Cancer Registry information?

“…Incidence rates are dependent upon diagnostic activity. Although there is no governmentally approved prostate cancer screening in Norway, opportunistic screening is clearly ongoing (3). Differences in the natural course of the disease may influence the survival rates, along with differences in national health care strategies as to treatment and follow-up.…”