The early detection of prostate cancer in general practice: Supporting patient choice

Abstract

Background Prostate cancer is the most commonly diagnosed cancer in men in New Zea-land and the third most common cause of male cancer deaths, account-ing for 3.8% of deaths.1 The incidence of prostate cancer has risen rapidly over the past 15-20 years but this is likely to be the result of increased numbers of asymptomatic men un-dergoing prostate specific antigen (PSA) testing.2 Prostate cancer is very rare in men below the age of 50. About 90% of all new cases are in men aged 60 or older, and two-thirds of the men who die from the disease are over age 75.1 The registration rate for new pros-tate cancers in Maori is lower than for non-Maori (71.3 per 100000 population compared with 96.2 per 100000 population), but these rates are based on relatively small num-bers, and there has been variable re-cording of ethnic data, so the esti-mates for Maori men are less robust.2 Risk of diagnosis of, and deaths from, prostate cancer are very much age-related - the risk of diagnosis in men aged 70-79 being nearly seven times greater than that in men aged 50-59, and the risk of death being 21 times greater (Table 1). However, premature death from prostate cancer is more likely for men diagnosed in their 50s com-pared to men in their 70s (Table 2). Family history increases the risk of developing prostate cancer - a man with a father or brother diagnosed has at least twice the risk of diag-nosis,4 and this increases with de-creasing age of the affected relative. There is also wide international vari-ability in incidence rates of pros-tate cancer, with high rates in those of African American background and low rates in Japanese.5