Prostate cancer (unless in cases of urinary tract obstruction, metastases, and related disorders which occur in advanced disease) is usually asymptomatic. In Greece, a non-symptomatic patient would never visit an urologist, unless consulted by another physician. As a result, in several patients the diagnosis of prostate cancer is attained at a stage when surgical therapy is not an option. Thus, the contribution of the general practitioner on prostate cancer screening is substantial. We agree with Schwartz et al (“Screening for prostate cancer: Who and how often?,” J Fam Pract 2005; 54:586–596) that prostate-specific antigen (PSA) as a screening test performed alone can be misleading, resulting in a possible overdiagnosis and treatment of clinically insignificant cancers.
However, based on our experience in prostate cancer screening in our daily practice (from the prospective of the general practitioner in primary health care settings), we observed that in a series of males screened for prostate cancer in the Urban Health Center of Vyronas (in the period September 2004 to February 2005), the accuracy of PSA for prostate cancer screening was greatly improved when performed after a positive digital rectal examination (DRE).1 Among patients with positive DRE and a PSA value over the age-specific limit, 94% had clinically significant prostate cancer and most of them underwent surgery. Although positive prognostic value of DRE is respectively low, it remains a major tool in presymptomatic control for prostate cancer and can contribute as a useful screening method in the hands of general practitioners. Moreover, the implication of health education programmes concerning the importance of DRE in men aged >50 years is imperative, as shown by the percentage of DRE denial in our study (86.6%).
Dr. Alevizos Alevizos
General Practitioner, Urban Health Center of
Vyronas, Athens, Greece