title: A 10-year analysis of metastatic prostate cancer as an initial presentation in an underserved population.
abstract: OBJECTIVE
  To analyze patients from an underserved area who presented initially with metastatic prostate cancer in order to identify patients in our population who would suffer greatly if PSA screening was eliminated.
  
  
  METHODS
  A prospectively maintained androgen deprivation therapy database from an inner city municipal hospital was queried to identify patients who presented with metastatic prostate cancer. We identified 129 individuals from 1999 to 2009 eligible for study. Those who underwent previous treatment for prostate cancer were excluded. We examined metastatic distribution and analyzed survival using Kaplan Meier probability curves.
  
  
  RESULTS
  The median age of presentation was 68 with a median Gleason sum of 8 per prostate biopsy. Thirty-two patients presented with hydronephrosis with a median creatinine of 1.79, two of whom required emergent dialysis. Of those patients who underwent radiographic imaging at presentation, 35.5% (33/93) had lymphadenopathy suspicious for metastasis, 16.1% (15/93) had masses suspicious for visceral metastases. Of the patients who underwent a bone scan 93% (118/127) had positive findings with 7.9% (10/127) exhibiting signs of cord compression. The 2 and 5- year cancer specific survival was 92.1% and 65.6%, respectively.
  
  
  CONCLUSIONS
  In this study we have highlighted a group of men in an underserved community who presented with aggressive and morbid PCa despite widespread acceptance of PSA screening.
authors.affiliation: Department of Urology, SUNY Downstate Medical Center and Kings County Medical Center, Brooklyn, NY, USA.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Winer
authors.affiliation: Department of Urology, SUNY Downstate Medical Center and Kings County Medical Center, Brooklyn, NY, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Sfakianos
authors.affiliation: Department of Urology, SUNY Downstate Medical Center and Kings County Medical Center, Brooklyn, NY, USA.
authors.forename: Llewellyn M
authors.initials: LM
authors.lastname: Hyacinthe
authors.affiliation: Department of Urology, SUNY Downstate Medical Center and Kings County Medical Center, Brooklyn, NY, USA.
authors.forename: Brian K
authors.initials: BK
authors.lastname: McNeil
mesh_terms: D001741:Black or African American; D000368:Aged; D001706:Biopsy; D003404:Creatinine / Q000032:analysis; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008403:Mass Screening / Q000379:methods*; D060787:Neoplasm Grading; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology*; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D035862:Vulnerable Populations / Q000706:statistics & numerical data*
chemical_list: D003404:Creatinine; D017430:Prostate-Specific Antigen