title: Risk profiles of prostate cancers identified from UK primary care using national referral guidelines.
abstract: OBJECTIVE
  Prostate cancer in the United Kingdom is mainly diagnosed from primary care referrals based on national guidelines published by the Department of Health. Here we investigated the characteristics of cancers detected through the use of these guidelines.
  
  
  METHODS
  A prospective two-centre study was established to assess men referred from the primary care based on the UK national guidelines.
  
  
  RESULTS
  The overall cancer detection rate was 43% (169 out of 397) with 15% (26 out of 169) of all cancers metastatic at presentation. Amongst 50-69-year-old men these rates were 34% (68 out of 200) and 15% (10 out of 68). Only 21% (25 out of 123) of men with local cancers had low-risk disease. In comparison to a historical cohort from 2001 (n=137) we found no overall differences in rates of metastatic disease, locally advanced tumours, or risk categories. Amongst 50-69-year-old men with local disease, however, we observed an increase in detection of low-risk cancers in a contemporary cohort (P=0.04). This was primarily because of the increased detection of low-stage organ-confined tumours in this group (P=0.02).
  
  
  CONCLUSIONS
  Use of the UK prostate cancer guidelines detects a high proportion of clinically significant cancers. Use of the guidelines does not seem to have led to an overall change in the clinical characteristics of presenting cancers. There may, however, be a specific benefit in detecting more low-risk disease in younger men.
authors.affiliation: Department of Urology, Addenbrookes Hospital, Hills Road, Cambridge CB2 0XZ, UK.
authors.forename: H
authors.initials: H
authors.lastname: Serag
authors.forename: S
authors.initials: S
authors.lastname: Banerjee
authors.forename: K
authors.initials: K
authors.lastname: Saeb-Parsy
authors.forename: S
authors.initials: S
authors.lastname: Irving
authors.forename: K
authors.initials: K
authors.lastname: Wright
authors.forename: S
authors.initials: S
authors.lastname: Stearn
authors.forename: A
authors.initials: A
authors.lastname: Doble
authors.forename: V J
authors.initials: VJ
authors.lastname: Gnanapragasam
mesh_terms: D000368:Aged; D019985:Benchmarking; D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D004739:England / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D012017:Referral and Consultation; D012042:Registries; D012307:Risk Factors; D013222:State Medicine / Q000592:standards*