INCIDENCE, RACIAL-DIFFERENCES, AND PROGNOSTIC-SIGNIFICANCE OF PROSTATE CARCINOMAS DIAGNOSED WITH OBSTRUCTIVE SYMPTOMS

Background. It is unknown how often prostate carcinomas are diagnosed as a result of urinary obstructive symptoms or whether prostate carcin omas diagnosed because of obstructive symptoms have a favorable or unf avorable prognosis. It is also unknown whether racial differences in o bstructive symptoms could help explain why black men with prostate car cinoma are diagnosed with more advanced stages and grades of prostate carcinoma than are white men with prostate carcinoma. Method. At a sin gle Veterans Administration Medical Center, 478 consecutive cases of p rostate carcinoma diagnosed between 1973 and 1985 were identified. The incidence of obstructive symptoms at diagnosis, racial differences in obstructive symptoms, and the survival of patients with and without o bstructive symptoms, stratified by stage and grade, were determined. I n addition, racial differences in the frequency of surgical interventi on required to relieve the obstructive symptoms were determined. Resul ts. All patients diagnosed with Stage A prostate carcinoma and most (8 2%) patients diagnosed with Stage C prostate carcinoma had obstructive symptoms. Those diagnosed with Stage B and Stage D prostate carcinoma s had with similar frequencies (53% and 55%, respectively) of obstruct ive symptoms. Survival, stratified by stage and grade, was similar for men with and without obstructive symptoms. The incidences of obstruct ive symptoms and the frequency of surgical intervention to relieve the obstructive symptoms, stage for stage, were similar for white and bla ck men. Conclusion. Survival, stratified by stage and grade, is not af fected adversely by obstructive symptoms. Neither racial differences i n the incidence of obstructive symptoms nor the frequency with which o bstructive symptoms require surgical correction explain why black men with CAP consistently are diagnosed more frequently with Stage D prost ate carcinoma and less frequently with Stage A CAP than white men with CAP.