title: Differences in cancer characteristics of Chinese patients with prostate cancer who present with different symptoms.
abstract: BACKGROUND
  Currently there is no structured prostate cancer screening programme in Asia. Early diagnosis of prostate cancer in Asia is by an opportunistic case-finding approach, that is, offering prostate-specific antigen testing to an individual without obvious symptoms of prostate cancer. In this study, we investigated the relationship between the mode of presentation and the characteristics of prostate cancers diagnosed in our hospital.
  
  
  METHODS
  We recruited 120 consecutive Chinese patients with prostate cancer newly diagnosed from September 2011 to February 2013 in a regional hospital in Hong Kong. Patient demographics, symptoms, presentation, staging, and risk profiles were collected and analysed.
  
  
  RESULTS
  The number of subjects diagnosed during a health check (group 1), investigated for symptoms with no/low suspicion of prostate cancer (group 2), investigated for symptoms where prostate cancer was suspected (group 3), or who had undergone transurethral prostatectomy (group 4) were 12 (10.0%), 53 (44.2%), 46 (38.3%), and nine (7.5%), respectively. Overall mean age was 71.0 (range, 54-90) years, and patients in group 3 were significantly older than those in groups 1 and 2 (P<0.001). Patients in group 3 had a significantly higher level of serum prostate-specific antigen, higher incidence of abnormal digital rectal examination, and more metastatic disease at presentation than the other groups. Nonetheless, more than 50% of the prostate cancers in groups 1 and 2 were of intermediate risk or higher staging at presentation. After a median follow-up of 32 months, cancer-specific survival was 100% for each of groups 1, 2, and 4 but was only 76.8% for group 3 (P=0.006).
  
  
  CONCLUSIONS
  Patients with prostate cancer who presented with prostate cancer-related symptoms had more metastatic disease and poorer survival than patients diagnosed by a case-finding approach. Moreover, more than half of those patients diagnosed by case finding belonged to intermediate- or higher-risk groups for which active treatment was recommended.
authors.affiliation: SH Ho Urology Centre, Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: S Ys
authors.initials: SY
authors.lastname: Chan
authors.affiliation: SH Ho Urology Centre, Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: C F
authors.initials: CF
authors.lastname: Ng
authors.affiliation: SH Ho Urology Centre, Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: K Wm
authors.initials: KW
authors.lastname: Lee
authors.affiliation: SH Ho Urology Centre, Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: C H
authors.initials: CH
authors.lastname: Yee
authors.affiliation: SH Ho Urology Centre, Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: P Kf
authors.initials: PK
authors.lastname: Chiu
authors.affiliation: SH Ho Urology Centre, Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: J Yc
authors.initials: JY
authors.lastname: Teoh
authors.affiliation: SH Ho Urology Centre, Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: S Sm
authors.initials: SS
authors.lastname: Hou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D051517:Digital Rectal Examination; D055088:Early Detection of Cancer; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000628:therapy
chemical_list: D017430:Prostate-Specific Antigen
keywords: Mass screening; Prostatic neoplasms; Risk; Survival analysis