Practice patterns regarding prostate cancer and benign prostatic hyperplasia in Japanese primary care practitioners

Although primary care practitioners (PCP) take an active role in diagnosis of prostate disorders in Western countries, how PCP take part in management of prostate disease still differs worldwide by country. We investigated practice and referral patterns concerning prostate disease among Japanese PCP and compared these with reported patterns in the West.

A 26-question multiple-choice questionnaire was mailed to 935 PCP in Tokyo for anonymous completion. Most items involved prostate cancer screening or management of benign prostatic hyperplasia (BPH).

The survey was completed by 281 non-urological practitioners, among whom digital rectal examination was performed by 43%. Prostate-specific antigen (PSA) was determined in serum by 89%. For asymptomatic men older than 50, serum PSA was determined routinely each year by only 17%. When PSA was 4.1-10.0 ng/mL, 70% of respondents immediately referred patients to urologists, while 18% did not make a referral unless PSA exceeded 10.0 ng/mL. Seventy-four percent prescribed medication for benign prostate hypertrophy; among these respondents, 87% reported common use of alpha-blockers. Although 31% of respondents were aware of the International Prostate Symptom Score (IPSS), only 2% used it.

Although Japanese PCP were involved increasingly in diagnosis and management of prostate disease, degree and proficiency of involvement were too limited and less than in Western countries. Continuing medical education appears desirable for PCP in Japan regarding prostate disease.