title: Comparison of clinical and pathologic findings of prostate cancers detected through screening versus conventional referral in Brazil.
abstract: BACKGROUND
  Data regarding prostate cancer screening in Brazil are limited. We compared features of prostate cancers detected through screening versus those referred for treatment in Brazil.
  
  
  METHODS
  Group I included 500 of 13,754 men whose cancers were detected through screening, and Group II included 2731 men referred for treatment through the habitual public health system. We used Mann-Whitney and χ(2) tests to compare clinical and pathologic findings, considering significant any P < 0.05.
  
  
  RESULTS
  Median prostate-specific antigen (PSA) was lower among screened patients (5.5 ng/mL versus 10.0 ng/mL; P < 0.001). Of the screened patients, 170 (34%) had biopsy Gleason score ≥ 7, compared with 1265 (46.3%) in the referred group (P < 0.001). Lymph node metastases were suspected in 8.6% of the referred versus 3.2% of the screened men (P = 0.002). Distant metastases were more common in the referred men (9.3% vs. 3.0%; P < 0.001). Only 6.0% of the screened cancers were locally advanced at diagnosis (T3 or T4) versus 26.5% of the referred (P < 0.001). Screened patients had a higher proportion of localized tumors after surgery (67.7% vs. 54.2%; P = 0.002). Pathology Gleason scores were also lower among screened men (P < 0.01). Lymphadenectomies were performed in 166/636 men (26.1%). No nodal metastases were found in screened cancers (0/28; 0.0%), while 6/138 referred cancers (4.3%) presented nodal involvement (P = 0.3).
  
  
  CONCLUSIONS
  Clinical and pathologic characteristics of screen-detected cancers are more favorable than those of tumors diagnosed through the Brazilian health system.
authors.affiliation: Division of Urology, Barretos Cancer Hospital, Antenor Duarte Villela 1331, Barretos, SP, Brazil. elineyferreirafaria@yahoo.com.br
authors.forename: Eliney F
authors.initials: EF
authors.lastname: Faria
authors.forename: Gustavo F
authors.initials: GF
authors.lastname: Carvalhal
authors.forename: René A
authors.initials: RA
authors.lastname: Vieira
authors.forename: Thiago B
authors.initials: TB
authors.lastname: Silva
authors.forename: Edmundo C
authors.initials: EC
authors.lastname: Mauad
authors.forename: Marcos
authors.initials: M
authors.lastname: Tobias-Machado
authors.forename: André L
authors.initials: AL
authors.lastname: Carvalho
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology*
chemical_list: D017430:Prostate-Specific Antigen