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

Objective: 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).

Patients and methods: 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.

Results: 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.

Conclusion: 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.