Posted: Wednesday, November 23, 2022
The common perception of male urinary symptoms as key indicators of prostate cancer is reinforced by national guidelines and media health-promotion messaging, according to an article published in BMC Medicine. However, Vincent J. Gnanapragasam, MA, FRCSEd (Urol), FRCS, PhD, BMedSci, MBBS, of the University of Cambridge, England, and colleagues noted this narrative is not based on evidence and may hinder efforts to encourage early patient presentation.
“We therefore call on guideline bodies, charities, and the media to take urgent action to review the current public messaging and referral recommendations,” the investigators commented. “Efforts should…be made to raise awareness that prostate cancer does not manifest with urinary symptoms.”
Prostate cancer most often arises in the peripheral zone, whereas urinary symptoms result from compression of the urethra by central prostatic enlargement. Patients with biopsy-confirmed early-stage prostate cancer were found to have a lower mean prostate volume than those with benign biopsies. As a result of the inverse relationship between prostate size and the probability of cancer, prostate-specific antigen (PSA) density has been found to be significantly more accurate in predicting a positive biopsy than PSA assessment alone.
Compared with PSA testing or screening programs, using the onset of lower urinary tract symptoms as a trigger to investigate possible cancer may lead to a higher proportion of patients presenting with locally advanced or metastatic disease. Modern approaches, such as image-based diagnostics and risk-adapted management strategies, may be applied to reduce overinvestigation and overtreatment of patients without symptoms.
“We are not here advocating for an immediate screening program, nor are we asking to change already existing pathways,” the investigators concluded. “Eventually, we hope that an intelligent tiered screening program will be possible, but until then, a simple change in message to correct years of misinformation would be a strong starting point.”
Disclosure: The study authors reported no conflicts of interest.