Hamilton William, Sharp Deborah J, Peters Tim J, Round Alison P
Department of Community Based Medicine, University of Bristol, The Grange, 1 Woodland Road, Bristol BS8 1AU.
Br J Gen Pract. 2006 Oct;56(531):756-62.
Even in areas where screening is available, many prostate cancers are diagnosed after the symptoms begin. However, the risk posed by particular symptoms is largely unknown, especially in unselected populations such as primary care.
To identify and quantify the features of prostate cancer before diagnosis, both individually and in combination.
Population-based case-control study.
All 21 general practices in Exeter, Devon, UK.
We studied all 217 prostate cancer patients diagnosed between 1998 and 2002, and 1080 male controls, matched by age and general practice. The full medical record for 2 years before diagnosis was coded, using the International Classification of Primary Care. We calculated odds ratios for variables independently associated with cancer, using conditional logistic regression, and calculated the positive predictive values for these, both individually and in combination.
Eight features were associated with prostate cancer before diagnosis. Their positive predictive values against a background risk of 0.35% were: urinary retention 3.1% (95% confidence interval [CI] = 1.5 to 6.0); impotence 3.0% (95% CI = 1.7 to 4.9); frequency 2.2% (95% CI = 1.3 to 3.5); hesitancy 3.0% (95% CI = 1.5 to 5.5); nocturia 2.2% (95% CI = 1.2 to 3.6); haematuria 1.0% (95% CI = 0.57 to 1.8); weight loss 0.75% (95% CI = 0.38 to 1.4); abnormal rectal examination, deemed benign 2.8% (95% CI = 1.6 to 4.6); abnormal rectal examination, deemed malignant 12% (95% CI = 5.0 to 37): all P <0.001, except for hesitancy P = 0.032, nocturia P = 0.004 and haematuria P = 0.009. Loss of weight, impotence, frequency and abnormal rectal examination remained associated with cancer after excluding the final 180 days from analysis.
Most men with prostate cancer present with symptoms. The predictive values for these symptoms will help guide GPs and patients about the value of further investigation.
即使在可进行筛查的地区，许多前列腺癌也是在症状出现后才被诊断出来。然而，特定症状所带来的风险在很大程度上尚不清楚，尤其是在如初级保健这类未经过筛选的人群中。
单独及综合识别并量化前列腺癌诊断前的特征。
基于人群的病例对照研究。
英国德文郡埃克塞特市的所有21家全科诊所。
我们研究了1998年至2002年间确诊的所有217例前列腺癌患者以及1080名男性对照者，对照者按年龄和全科诊所进行匹配。使用国际初级保健分类法对诊断前2年的完整病历进行编码。我们采用条件逻辑回归计算与癌症独立相关变量的比值比，并分别及综合计算这些变量的阳性预测值。
八个特征与前列腺癌诊断前相关。在背景风险为0.35%的情况下，它们的阳性预测值分别为：尿潴留3.1%（95%置信区间[CI]=1.5至6.0）；阳痿3.0%（95%CI=1.7至4.9）；尿频2.2%（95%CI=1.3至3.5）；排尿犹豫3.0%（95%CI=1.5至5.5）；夜尿2.2%（95%CI=1.2至3.6）；血尿1.0%（95%CI=0.57至1.8）；体重减轻0.75%（95%CI=0.38至1.4）；直肠指检异常（判定为良性）2.8%（95%CI=1.6至4.6）；直肠指检异常（判定为恶性）12%（95%CI=5.0至37）：除排尿犹豫P=0.032、夜尿P=0.004和血尿P=0.009外，所有P<0.001。在分析中排除最后180天后，体重减轻、阳痿、尿频和直肠指检异常仍与癌症相关。
大多数前列腺癌患者有症状表现。这些症状的预测值将有助于指导全科医生和患者了解进一步检查的价值。
