Objective: To assess whether the increased use of prostate-specific antigen (PSA) testing over the last 15 years has changed the way prostate cancer presents in an inner city UK population, where PSA screening rates might be expected to be lower than in epidemiological studies based in North America, where there is a significant tendency to a localized stage and earlier age at diagnosis.
Patients and methods: The study comprised a 5-year retrospective and 5-year prospective analysis of data on 704 men diagnosed with prostate cancer over the 10-year period since the introduction of PSA testing (1994-2003).
Results: The median (range) age at presentation remained unchanged, at 72 (45-94) years; the PSA level at diagnosis was 20-46 microg/L, with a steady decline after 1997. There was no significant change in stage at diagnosis; overall, 38 (20-44)% presented with clinically localized disease, 37 (31-48)% with locally advanced and 25 (18-29)% with metastatic disease. The Gleason grade changed significantly, with more moderately differentiated tumours and a decline in well-differentiated cancers. Closer examination showed this to have been due to a change in diagnostic practice rather than a true population trend. PSA testing increased over the 10 years of the study (2.35 times), with requests from general practitioners rising seven times, compared with urologists or other hospital doctors (1.25 and 2.3 times, respectively). Community PSA testing remained lower than in other reported UK series, which may be explained in part by the lower socio-economic status of the population assessed.
Conclusion: There was no apparent change in patient age or tumour stage in men presenting with prostate cancer over a 10-year period after the introduction of PSA testing. While there was an increase in PSA testing during the study period, the testing rate remains much lower than in other reported series from the UK.