Epidemiology and Diagnosis

The population incidence of prostate cancer has dramatically increased since the advent of PSA testing. It now represents the most common cancer in males, although this includes many cancers not requiring intervention other than monitoring, and is among the leading causes of cancer death in men. This does not mean that the true incidence of prostate cancer is higher, but that more cases are being diagnosed than previously. Most men presenting acutely with symptoms of UR of any cause will most likely have BPH, but several large population studies have shown that a significant proportion of these will have clinically undetectable foci of prostate cancer. This proportion increases dramatically with age (Johansson et al. 2004; Kessler and Albertsen 2003).

The patient may present in exactly the same manner as the patient with BPH, i.e., in AUR or less commonly CUR. On initial assessment, it maybe evident that they are under investigation for, or being treated for, prostate cancer. DRE may reveal an overtly malignant-feeling prostate, or more commonly a benign-feeling gland. If there is no history of prostate cancer, and the DRE is benign, then one should proceed as per AUR secondary to BPH, and PSA should be checked once voiding is re-established. There is little use in checking PSA acutely, as it will be raised secondary to the episode of AUR. If there is a history of prostate cancer or investigation into the same, or the DRE is suspicious for malignancy, then a different approach should be taken; see Sect. 11.2.3.3.

If the patient is known to have prostate cancer that is being monitored for presumed small-volume organ-confined disease, then episodes of AUR can represent local disease progression, which should alter management, unless this is contrary to the patient's wishes.

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