Topic in focus: signs and symptoms suggestive of a prostate cancer diagnosis in primary care
by NZGG
Introduction
Prostate cancer is the second most common cause of male cancer deaths in New Zealand (or the third highest age-standardised rate of death). The large majority of deaths occur in men older than 70 years.
Figures described here are from a non-screened population. Prostate cancer is currently detected in symptomatic men or in asymptomatic men who decide to undergo investigation (opportunistic screening).
In New Zealand, incidence (1996 to 2000) was highest in Pacific men (65 years or older), followed by European/Other New Zealand men and Maori men. However, Maori men are more likely to be diagnosed at a later disease stage and, after diagnosis, are more than twice as likely as European/Other New Zealand men to die of prostate cancer. Pacific men had higher mortality rate compared with the rest of New Zealand men.
The Suspected Cancer in Primary Care guideline encompasses only those patients who present with signs and symptoms to primary care, and the subsequent referral steps. For prostate cancer, urinary tract symptoms include frequency, hesitancy and nocturia.
Key messages from the Suspected Cancer in Primary Care guideline Urgent referral to a specialist is indicated if a man presents with:
- Lower urinary tract symptoms AND
– Hard irregular prostate (on DRE), OR
– High PSA (>10 ng/ml), OR
– Raised or rising age-specific PSA (and normal DRE)
- Unexplained symptoms suggestive of metastatic prostate cancer e.g.
– Lower back pain
– Bone pain
– Weight loss (especially in elderly men)
These recommendations are supported by international expert opinion.
Good practice points include:
- Urgent specialist referral for men presenting with macroscopic haematuria.
- Referral to specialist in cases of enlarged smooth prostate on DRE and normal PSA only if macroscopic haematuria present.
- DRE and PSA for older men presenting with lower urinary tract symptoms.