Awareness of prostate cancer diagnosis and management among Turkish males: a cross sectional study from Çorum

Abstract

Introduction: Prostate cancer is the most common malignancy among men in the United States and the second most common cancer in Turkey. The incidence of prostate cancer is increasing in industrialized countries.

Aim: The aim of the study was to assess the knowledge about prostate cancer, its diagnosis, and treatment among patients with lower urinary tract symptoms.

Methods: This study was performed from January to April 2015 with the patients applied to our clinic. A questionnaire that includes 10 questions was administered to the participants.

Results: One hundred fifty-nine participants were included in this study. The participants’ ages were between 40 and 82 with a mean age of 61.5 ± 7.9 years. Patient awareness of prostate biopsy and prostate cancer were 21.37 and 71.06%. The main origin awareness of PSA testing is family and friends. On the other hand, if the doctor advises acout prostate biopsy, 47.16% of the patients would accept and 11.31% of them would refuse this invasive procedure.

Conclusion: Prostate cancer is one of the important health-related problem among men in the world. Additional researches are needed to investigate the knowledge of prostate cancer among men and the Ministry of Health may take preventive methods to increase the cancer knowledge level of people.

Keywords:

• Benign prostate hyperplasia
• prostate cancer
• prostate specific antigen

Introduction

Prostate cancer (PC) is the most common malignancy among elderly men and has emerged as the most frequent cancer amongst men with rapidly increasing incidence over the past two decades in Europe [1]. PC detected at an early stage can be successfully eradicated by radical prostatectomy and radiotherapy. Unfortunately, there is no curative treatment for metastatic diseases [2,3]. Serum prostate-specific antigen (PSA) levels are known to be associated with prostate cancer risk [4]. It is the second leading cancer deaths among males in the USA. American PC proportion in 2011 is approximately 29% among all cancer diagnoses and responsible for 11% of all cancer deaths [5]. The incidence of prostate cancer is increasing also in the USA, mostly due to increased awareness and screening [6].

According to a study by the World Health Organization, the incidence of prostate cancer was between 17.1 and 36.3/100,000 in Turkey region of Edirne, Trabzon, Antalya, and İzmir cities [7]. An incidence study from Turkey (ProstatTURK), PC was the second most common cancer in men and the incidence was reported to be 35/100,000 [8]. This incidence is 272/100,000 in African-Americans and decreases to 2.9/100,000 in China. The risk of getting a PC increases after 50 years of age and the highest incidence is in the eight decades [9]. In addition, men with a family history of PC have an increased risk of getting PC [10]. Routine screening of PC can lead to early detection of disease and have a favourable outcome [11]. According to a study from the USA, authors found a positive relationship between low-level income and low levels of knowledge about PC, which was attributed to poor access to information sources [12]. The aim of the study is to assess the knowledge about prostate cancer, its diagnosis, and treatment among the patients who were admitted to our clinic with lower urinary tract symptoms.

Material and methods

This study was conducted in Hitit University Erol Olcok Education and Research Hospital from January 2015 to April 2015. The patients who presented with lower urinary tract symptoms were informed and volunteers were included in the study. The questionnaire consisted of 10 questions that are about symptoms, previous therapy, surgical treatment choice, prostate biopsy, prostate cancer, and PSA. The patients with a history of prostate cancer and surgical treatment for benign prostate hyperplasia were excluded from the study.

Results

There were 159 patients in this study. The patients’ ages were between 42 and 82 with a mean age of 61.5 ± 7.9 years. Table 1 shows the education levels of the patients. Most of the patients (more than 50%) have lower urinary tract symptoms for more than one year. History of treatment with medical or phytotherapy consisted of 45.9% of the patients. The questionnaire and answers of the patients were seen in Table 2. For the surgical treatment, the patients prefer open and endoscopic surgery with 1.92% and 8.33%, respectively. Most of the patients (68.58%) agree with the doctor’s choice for the type of surgery. The patients who refused surgery are 18.58% of the total patients and the main cause of refusal for surgery thought there was no benefit after surgery. Patient awareness of prostate biopsy and prostate cancer is 21.37 and 71.06%. PSA testing is a known procedure by 25.78% of the patients. Most of the patients knew about PSA from family and friends.

Table 1. Education levels of the patients.

Education	Number (%)
Illiterate	4 (2.7)
Literate	7 (4.72)
Primary and secondary	106 (71.61)
High	17 (11.48)
University	14 (9.45)

Table 2. The questionnaire and answers of the patients.

Questions and answers	n(%)
Times of lower urinary tract symptoms	159 (100)
One month	27 (16.98)
Siz months	31 (19.49)
A few years	57 (35.84)
≥5 years	44 (27.67)
Any treatment before	159 (100)
Medical treatment	71 (44.65)
Phytotherapy	2 (1.25)
No	86 (54.08)
Which surgical approach do you prefer?	156 (100)
Green light	4 (2.56)
Endoscopic	13 (8.33)
Open	3 (1.92)
The doctor’ advise	107 (68.58)
I refuse the operation	29 (18.58)
If you refuse the surgery, what is the reason?(One or more)	28 (100)
No benefit of the operation	13 (46.42)
Sexual problems after the operation	1 (3.57)
Afraid of the operation	11 (39.28)
Incontinence after the operation	3 (10.71)
Does your prostate disease affect sexuality?	159 (100)
Yes	73 (45.91)
No	86 (54.08)
Do you know the prostate biopsy?	159 (100)
Yes, I heard this procedure	31 (19.49)
Yes, I know this procedure and which patients needs biopsy	3 (1.88)
No, I did not hear before	125 (78.61)
Do you agree if the doctor advise prostate biopsy?	159 (100)
Yes	75 (47.16)
I think a little	66 (41.50)
No	18 (11.31)
Have you any information about the prostate cancer?	159 (100)
I heard prostate cancer disease	105 (66.03)
I know this disease with detailed information	8 (5.03)
I have not heard this disease before	46 (28.93)
Do you know prostate specific antigen (PSA) testing for early diagnosis of prostate cancer?	159 (100)
Yes, I heard PSA testing before	33 (20.75)
Yes, I know PSA testing and do regular interval	8 (5.03)
No, I did not hear this testing	118 (74.21)
Where did you learn PSA testing?	34 (100)
Family and friends	20 (58.82)
Television	6 (17.64)
Internet	2 (5.88)
Doctors	6 (17.64)

Discussion

The primary goal of PSA screening is to prevent and reduce death-related prostate cancer [7]. The results of two different randomized controlled studies from the USA and Europe have conflicting results for PSA screening. The Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening study from the USA found no mortality reduction with PSA screening programme and digital rectal examination [13], European Randomized Study of Screening for Prostate Cancer (ERSCP) reported that screening reduces prostate cancer-specific mortality [14]. According to a study from Arabic countries, the authors reported that the knowledge of PSA screening for PC is approximately 48, 55, and 58% of the patients from Saudi Arabia, Egypt, and Jordan [15]. A study from the USA included 1089 patients, 39% of the patients had never received PSA test before [16]. The investigators reported that media represents an important strategic tool about health information [17]. Public knowledge and information on cancer prevention are largely influenced by television and radio rather than health professionals, because public spend more time in front of television and radio than with healthcare providers. In the current study, 20.75% of the patients have heard of PSA and only 5.03% of the patients do this test at regular intervals. Of these patients; 58.82, 17.64, 5.88, and 17.64% have heard from friends and family, television, internet, and physicians, respectively.

Prostate examination and PSA testing are the two methods for early diagnosis of PC [18]. Final diagnosis needs performance using needle biopsy of the prostate. However, the positive predictive value of biopsy is about 24% and have some adverse events such as pain, infection, bleeding, and urinary symptoms, so some patients refuse to undergo this invasive procedure [19]. Avery et al. [20] reported that 29.1% of the patients refused the prostate biopsy and higher education level is associated with a statistically significant lower acceptance rate of the biopsy. López-Guarnido et al. [1] showed that 8.43% of the patients did not accept prostate biopsy and 52.5% of these patients had a managerial and professional occupational class. Our study revealed that 19.49% of the patients have heard about this procedure, 1.8% of them know detailed information about who needs a biopsy and 78.6% of the patients have no idea about this procedure. In addition, if the doctor advises prostate biopsy, 47.16% of the patients would accept and 11.31% of them would refuse this invasive procedure.

Prostate cancer is an important disease in men, especially over the age of 40 [11]. In a study from South Africa, the authors reported that 73.4% of the patients heard about the prostate cancer [21] and there is a significant association between the level of knowledge about prostate cancer and the level of school education and employment. In this study, 66.03% of the patients have heard about the prostate cancer disease, 28.93% of the patients did not hear before and only 5.03% of the patients have detailed information about prostate cancer. Of these patients (113 patients) who have heard and have detailed information about prostate cancer disease, 106 patients filled the education level. Most of the patients’ (57.54%) education level are primary and only 12.26% of the patients had a university level of education.

The authors reported that the most frequent motives of regular prostate examination were health assurance, physicians’ medical advice, checkup, and urological symptoms [11]. The main reasons are absence of urological symptoms, lack of physicians' advice, fear and anxiety in patients who have not done regular checkup.

There are some limitations in this study. This study includes small number of patients. Patients’ knowledge and education level in Çorum may not be similar all around the country. We need studies that include more patients from all region of Turkey.

In conclusion, although prostate cancer is one of the most common malignancy that affects the male population worldwide, the patients ignore examination of prostate because of the absence of urological symptoms, lack of physicians’ advice, fear and anxiety. Public knowledge must be increased with television, newspaper, and health conferences. The men can be informed with telephone messages for prostate cancer screening after the age of 50 years.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.