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Interpretation of such data requires care, as the presentation of prostate cancer could be altered or delayed in patients with lower testosterone levels.
In this study, we interrogated a UK regional cancer registry for patterns of changes in presentation of prostate cancer over the last 10 years.
Prostate cancer stage of T3, C or greater, recorded for the vast majority of patients from one of the tertiary hospitals in the SE zone of Nigeria, has been attributed to the late presentation of prostate cancer among these patients.
The trial showed a greater overall incidence of prostate cancer in the control group, but men treated with finasteride were more likely to have high grade tumors (Thompson et al 2003), suggesting that reduced androgen exposure of the prostate may delay the presentation of prostate cancer and/or promote advanced disease in some other way.
The existing evidence on the association between low socioeconomic position and delayed presentation of cancer is conflicting: low socioeconomic position has been found to be a risk factor for delay in presentation of prostate cancer, but not for delay in presentation of colorectal cancer or gynaecological cancer (Macleod et al, 2009).
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It also revealed that, with the exception of presenting PSA level, clinical presentation and management of prostate cancer were similar among all ethnicities.
The clinical presentation of advanced, lethal prostate cancer is dominated by symptoms and findings caused by bone metastases.
Deprived populations are known to have a lower rate of uptake for early diagnostic techniques such as PSA testing (Wannamethee and Shaper, 1997) and this is borne out by evidence that the presentation of men with prostate cancer has not changed over a number of years in some deprived populations, notwithstanding the advent of PSA testing (Mokete et al, 2005).
Multifocal presentation and focal heterogeneity of prostate cancer may lead to sampling errors for prognostic assessment much more frequently in prostate cancer as compared to breast cancer.
Diagnostic investigations, clinical stage of disease at presentation and initial management of prostate cancer in black and white men in the UK were analysed and published by the PROCESS study group in 2009.
Combined with automated registration and presentation, and potentially automated detection, of prostate lesions, mpMRI is poised to go through a second revolution in patient management, leapfrogging our current understanding of prostate cancer biology [ 59].
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com