Prostate cancer is the most common cancer among men in many countries. The aim of the present study was to find out how the symptoms leading to a diagnosis, diagnostic procedures and stages of the disease among prostate cancer patients have changed over a period of 20 years.
This chart review consisted of prostate cancer patients whose treatment was started in the years,and at the Oulu University Hospital.
Earlier prostatic disorders, specific urological symptoms, diagnostic procedures, the TNM classification and histological grade were recorded. The number of symptom-free prostate cancer patients increased over the 20 years, as did the number of men suffering from chronic prostatitis, although the latter increase was not statistically significant.
A drop in the number of clinical T4 cases and increase of clinical T1 and clinical T2 cases was recorded but no clear change in the histological distribution occurred.
The 5-year prostate cancer-specific survival improved significantly over the 20 years. The urologist was found to be the Ilkka paananen wife sexual dysfunction who was contacted first most often. Our data indicate that the number of prostate cancer patients has increased hugely over the period from to and although the clinical T stage has moved towards earlier stages, the proportion of well differentiated cancers remains low, so that most patients have clinically significant cancer with the need of some form of therapy.
Further, prostate cancer-specific survival improved significantly over the period. Prostate cancer incidence is continuously increasing among men, a trend that can be explained mostly by better diagnostic procedures and the increase in life expectancy for men [ 1 - 4 ].
Despite the huge efforts aimed at prostate cancer research, the prostate-specific antigen PSA still remains the main indicator for asymptomatic or mildly symptomatic prostate cancer detection [ 5 ]. The Ilkka paananen wife sexual dysfunction of the current study was to evaluate how the symptoms leading to prostate cancer diagnosis and the diagnostic procedures used have evolved in Northern Finland over a period of 20 years and what effects these changes have brought with them.
This period was selected mainly to evaluate the impact of PSA testing on these diagnostic and clinical aspects, as the early years reflect the pre-PSA era and the PSA test has been available in Finland since The investigation was retrospective and was based on the review of charts from prostate cancer patients at Oulu University Hospital, whose treatment was started in the years,and The reference area was served by one university hospital and four central hospitals which have employed at least one urologist since The total area comprisedinhabitants, of whomlive in the primary area of responsibility of the university hospital; these figures have remained quite stable since Most of the treatments provided in this reference area were not initiated at the university hospital but at the central and regional hospitals.
Only patients who were thought to be candidates for radical therapy were referred directly to the university hospital for evaluation. The register of the hospital was searched for patients treated for prostate cancer in the urological department or those who visited the outpatient department in the years in question.
This search yielded a total of patients. The following data were collected during patient chart review: Other notable symptoms such as bone pain, pathological fractures, anaemia, paraplegia, urinary retention and uraemia were also recorded.
Diagnostic procedures performed outside the hospital such as digital rectal examination DREcytology, biopsy, serum acid Ilkka paananen wife sexual dysfunction concentration, serum prostatic acid phosphatase concentration, serum PSA Ilkka paananen wife sexual dysfunction, alkaline phosphatase concentration values and at Oulu University Hospital laboratory tests, transrectal ultrasonography TRUScytology, biopsy, bone scan, X-ray, computed tomography CTmagnetic resonance imaging MRIdiagnostic transurethral resection of prostate TURPdate of diagnosis, urinary flow rate and volume of residual urine were ascertained separately.
We were also interested in the status of the first person to be contacted. The TNM classification [ 6 ] and histological findings were taken as part of the diagnosis. The TNM classification took the form of a pathological estimate if the patient had undergone radical prostatectomy, and in other cases it was just a clinical estimate. A histological grading into three World Health Organization classes well, moderately and poorly differentiated was used throughout almost the entire period concerned, except inwhen all patients were graded according to the Gleason classification.
These latter findings were therefore transformed on the assumption that Gleason scores 2 to 4 are identical to well differentiated adenocarcinoma of the prostate, 5 to 7 to moderately differentiated, and 8 to 10 to poorly differentiated.
Comparison between treatment years was done for Ilkka paananen wife sexual dysfunction data using the Chi-Square linear-by-linear association test.