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Br J Gen Pract. Oct 1, 2006; 56(531): 756–762.
PMCID: PMC1920715
Clinical features of prostate cancer before diagnosis: a population-based, case-control study
William Hamilton, MD, FRCP, FRCGP, Senior Research Fellow
Department of Community Based Medicine, University of Bristol
Deborah J Sharp, PhD, FRCGP, Professor
Department of Community Based Medicine, University of Bristol
Tim J Peters, MSc, PhD, CStat, FFPH, Professor
Department of Community Based Medicine, University of Bristol
Alison P Round, FFPH, MRCP, Director of Public Health
East Devon Primary Care Trust, Unit 1 Exeter International Office Park, Clyst Honiton
Address for correspondence Dr William Hamilton, Academic Unit of Primary Care, Department of Community Based Medicine, University of Bristol, The Grange, 1 Woodland Road, Bristol, BS8 1AU. E-mail: w.hamilton/at/bristol.ac.uk
Received November 2, 2005; Revised January 16, 2006; Accepted February 21, 2006.
Abstract
Background
Even in areas where screening is available, many prostate cancers are diagnosed after the symptoms begin. However, the risk posed by particular symptoms is largely unknown, especially in unselected populations such as primary care.
Aim
To identify and quantify the features of prostate cancer before diagnosis, both individually and in combination.
Design of study
Population-based case-control study.
Setting
All 21 general practices in Exeter, Devon, UK.
Methods
We studied all 217 prostate cancer patients diagnosed between 1998 and 2002, and 1080 male controls, matched by age and general practice. The full medical record for 2 years before diagnosis was coded, using the International Classification of Primary Care. We calculated odds ratios for variables independently associated with cancer, using conditional logistic regression, and calculated the positive predictive values for these, both individually and in combination.
Results
Eight features were associated with prostate cancer before diagnosis. Their positive predictive values against a background risk of 0.35% were: urinary retention 3.1% (95% confidence interval [CI] = 1.5 to 6.0); impotence 3.0% (95% CI = 1.7 to 4.9); frequency 2.2% (95% CI = 1.3 to 3.5); hesitancy 3.0% (95% CI = 1.5 to 5.5); nocturia 2.2% (95% CI = 1.2 to 3.6); haematuria 1.0% (95% CI = 0.57 to 1.8); weight loss 0.75% (95% CI = 0.38 to 1.4); abnormal rectal examination, deemed benign 2.8% (95% CI = 1.6 to 4.6); abnormal rectal examination, deemed malignant 12% (95% CI = 5.0 to 37): all P <0.001, except for hesitancy P = 0.032, nocturia P = 0.004 and haematuria P = 0.009. Loss of weight, impotence, frequency and abnormal rectal examination remained associated with cancer after excluding the final 180 days from analysis.
Conclusion
Most men with prostate cancer present with symptoms. The predictive values for these symptoms will help guide GPs and patients about the value of further investigation.
Keywords: diagnosis, primary health care, prostate cancer
Articles from The British Journal of General Practice are provided here courtesy of
Royal College of General Practitioners