Screening by lower urinary tract symptoms vs asymptomatic prostate-specific antigen levels leading to radical prostatectomy in Danish men: tumour characteristics and treatment outcome.

Abstract

To compare the tumour characteristics and treatment outcome in men undergoing radical prostatectomy (RP) for prostate cancer diagnosed with or with no lower urinary tract symptoms (LUTS). In Denmark, prostate-specific antigen (PSA) testing is recommended only in men with a family history of prostate cancer, or those with LUTS that could be caused by prostate cancer. However, increasingly many men undergoing RP are asymptomatic and are diagnosed as a result of unsystematic PSA screening. Data were collected prospectively from The Aarhus PC-project, comprising 585 consecutive Danish men treated with RP between 1997 and 2008 at Aarhus University Hospital; of these, 47 had a family history of prostate cancer and were therefore excluded. In all, 188 (35%) patients stated being asymptomatic at the diagnosis of cancer, while LUTS led to the diagnosis in 350 (65%). Except for tumour grade after RP there were no significant differences between these subpopulations in tumour characteristics and treatment outcome. Unexpectedly, the Gleason score of the RP specimen was a statistically significant prognostic indicator (P = 0.002) in favour of symptomatic patients. This study showed no association between LUTS and tumour characteristics or treatment outcome between symptomatic and asymptomatic patients undergoing RP. The Gleason score at RP and thereby the long-term prognosis in asymptomatic patients seems to be worse than in patients with LUTS.