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

To identify the pathways leading to the diagnosis of prostate cancer from a UK population perspective, including the role of prostate-specific antigen (PSA) testing.

We studied all 217 prostate cancers occurring in the region covered by Exeter Primary Care Trust, Devon, UK (population 128 700) between 1998 and 2002. The general practitioner's records for 2 years before diagnosis were used to identify the category of pathway to diagnosis.

Symptomatic presentation to primary care initiated the diagnostic process in 166/217 men (76%). The presenting symptoms were lower urinary tract symptoms (LUTS) in 151 men (70%), systemic symptoms and no LUTS in 12 (6%) and bowel symptoms with a rectal examination revealing an abnormal prostate in 3 (1%). Eighteen cases (8%) were diagnosed as a result of PSA screening in asymptomatic men. Diagnosis as an inpatient accounted for 33 cases (15%), 25 of whom (11%) had been admitted with urological problems, and 4% of cases had been admitted for non-urological problems. Of the 151 men who presented with LUTS, 91 (60%) had a PSA test in primary care, 15 (10%) had one in secondary care and 39 (17%) had a prostatectomy that revealed a cancer that had not previously been suspected. Most prostate cancers were diagnosed after presentation to primary care with LUTS. Presentation with disseminated disease was rare.

Screening by means of PSA testing remains uncommon in this area of the UK, in contrast to the situation in other countries. Most PSA tests performed in patients with prostate cancer were diagnostic rather than screening tests.