Fukagai Takashi, Maruyama Kunitaka, Nagata Masakazu, Morita Masashi, Naoe Michio, Yoshida Hideki
Department of Urology, Showa University, School of Medicine, Tokyo, Japan.
Int J Urol. 2007 May;14(5):412-5. doi: 10.1111/j.1442-2042.2007.01742.x.
Although primary care practitioners (PCP) take an active role in diagnosis of prostate disorders in Western countries, how PCP take part in management of prostate disease still differs worldwide by country. We investigated practice and referral patterns concerning prostate disease among Japanese PCP and compared these with reported patterns in the West.
A 26-question multiple-choice questionnaire was mailed to 935 PCP in Tokyo for anonymous completion. Most items involved prostate cancer screening or management of benign prostatic hyperplasia (BPH).
The survey was completed by 281 non-urological practitioners, among whom digital rectal examination was performed by 43%. Prostate-specific antigen (PSA) was determined in serum by 89%. For asymptomatic men older than 50, serum PSA was determined routinely each year by only 17%. When PSA was 4.1-10.0 ng/mL, 70% of respondents immediately referred patients to urologists, while 18% did not make a referral unless PSA exceeded 10.0 ng/mL. Seventy-four percent prescribed medication for benign prostate hypertrophy; among these respondents, 87% reported common use of alpha-blockers. Although 31% of respondents were aware of the International Prostate Symptom Score (IPSS), only 2% used it.
Although Japanese PCP were involved increasingly in diagnosis and management of prostate disease, degree and proficiency of involvement were too limited and less than in Western countries. Continuing medical education appears desirable for PCP in Japan regarding prostate disease.
在西方国家，虽然初级保健医生（PCP）在前列腺疾病的诊断中发挥着积极作用，但各国初级保健医生参与前列腺疾病管理的方式仍存在差异。我们调查了日本初级保健医生关于前列腺疾病的诊疗及转诊模式，并与西方国家报告的模式进行了比较。
向东京的935名初级保健医生邮寄了一份包含26个问题的多项选择题问卷，要求他们匿名填写。大多数问题涉及前列腺癌筛查或良性前列腺增生（BPH）的管理。
281名非泌尿外科医生完成了调查，其中43%的医生进行了直肠指检。89%的医生检测了血清前列腺特异性抗原（PSA）。对于50岁以上无症状男性，每年仅17%的医生常规检测血清PSA。当PSA为4.1 - 10.0 ng/mL时，70%的受访者立即将患者转诊给泌尿科医生，而18%的受访者在PSA超过10.0 ng/mL之前不会转诊。74%的医生为良性前列腺增生开药；在这些受访者中，87%报告常用α受体阻滞剂。虽然31%的受访者知晓国际前列腺症状评分（IPSS），但只有2%的人使用过。
虽然日本初级保健医生越来越多地参与前列腺疾病的诊断和管理，但参与程度和水平仍然有限，低于西方国家。日本的初级保健医生在前列腺疾病方面似乎需要继续医学教育。
