Prostate cancer in general practice. Results of a five year prospective clinical study in one practice

Despite the fact that 10% of men over 50 will develop clinically significant prostate cancer, little clinical research exists about the disease at the primary care level.

To examine the acceptability of using digital rectal examination (DRE) and prostate specific antigen (PSA) as early detection tests for prostate cancer in a general practice setting. Also, to examine the incidence of the disease, treatment received and outcomes for patients in the practice studied.

An opportunistic, prospective, practice based study involving men aged 40 years and over attending a suburban general practice over a five year period.

Acceptance of DRE and PSA was quite high with over 84% for the former and 98% for the latter. Watchful waiting (31%) was the commonest mode of treatment followed by hormone treatment and orchidectomy (both 24%). Only four patients (14%) had radical prostatectomies while two (7%) had radiotherapy. Six (67%) of the nine deaths were due directly to prostate cancer.

Guidelines to help general practitioners manage older men wishing to be tested for prostate cancer would be useful. Not all patients with abnormal tests necessarily proceed to further invasive investigations. There is a likelihood that the incidence of the disease is lower in general practice than hospital based studies suggest. Adequate counselling to facilitate informed decision making and minimise anxiety is essential.