Attitude Toward Prostate Cancer Screening in Hong Kong: The Importance of Perceived Consequence and Anticipated Regret

Prostate Cancer Presenting as Hip Pain at the Chiropractic Office: A Case Report and Literature Review

Prostate cancer is one of the most common cancers found in males, and it tends to metastasize to bony parts such as the hip, spine, and pelvis, resulting in pain and/or radicular pain, which can present similarly to musculoskeletal complaints. The lack of routine screening and musculoskeletal symptoms present challenges in the diagnosis of prostate cancer. We report the case of a 62-year-old male with no history of cancer and no previous prostate cancer screening who visited a chiropractor for the care of worsening left hip pain after a marathon. The patient visited other healthcare providers and was suggested to have degenerative conditions; he received nonsteroidal anti-inflammatory medication, physiotherapy, and acupuncture. Given the patient's limited improvement by other providers and neurological symptoms, the chiropractor requested lumbar spine radiography, which revealed suspected bone metastasis, and ordered a hip MRI accordingly. MRI findings suggested prostate cancer, and the chiropractor referred the patient to an oncologist, who performed additional imaging and testing to make a presumptive prostate cancer diagnosis. A literature search found nine cases of undiagnosed prostate cancer presenting to a chiropractor for care. All patients included in this case were older males with no previous prostate screening or bone metastasis. The study is focused on the need for a comprehensive evaluation of patients with hip pain during a chiropractic visit due to the chances of prostate cancer. There are higher chances of ignoring cancer symptoms during a hip examination. Comprehensive evaluation and advanced imaging could help chiropractors detect patients with prostate cancer.

Using the Revised Health Care System Distrust Scale to evaluate healthcare distrust among Chinese men in Hong Kong: An analysis from a prostate cancer screening behaviours survey

Information about the level of distrust in healthcare systems is very limited in Chinese populations, and no validated instrument has been developed to measure this distrust. Therefore, to begin addressing this research gap, this study evaluated the psychometric properties of a traditional Chinese version of the Revised Health Care System Distrust Scale and used it to assess the level of distrust in a healthcare system. The study involved a community-based personal interview survey of individuals in Hong Kong. A total of 340 men were randomly recruited. In addition to the distrust instrument, the two-item Trust in Physician Scale and the Patient Health Questionnaire-9 were used. The two-factor structure of the distrust scale was confirmed. The item-total correlations corrected for overlap were >0.4 for both the Competence and Values Distrust subscales, confirming the internal construct validity of the scale. The Cronbach's alpha coefficient was 0.77 for both subscales. The scores of both the Competence and Values subscales were moderately negatively correlated with the total score of the Trust in Physician Scale, providing support for convergent validity. Regarding known-group validity, the scale could differentiate people according to marital status, monthly personal income and severity of depressive symptoms. Moreover, we found that men who had previously undergone prostate cancer screening had higher Values Distrust scores than those who had not. The descriptive analysis showed that only about half of the participants reported that they received high-quality medical care and that the healthcare system provided excellent medical care, suggesting that more effort is needed to improve the quality of care and people's satisfaction with healthcare in Hong Kong. In summary, the translated traditional Chinese version of the Revised Health Care System Distrust Scale used in this study is a valid and reliable scale for assessing the level of distrust in a healthcare system.

Presumptive Prostate Cancer Presenting as Low Back Pain in the Chiropractic Office: Two Cases and Literature Review

Prostate cancer is a common type of cancer in men and may metastasize to the spine and pelvis, causing back and/or radicular pain that appears to be musculoskeletal. This presents a diagnostic challenge and can be complicated by a lack of routine screening for prostate cancer. In two similar cases, elderly males (ages 78 and 82) with no known history of cancer and no previous prostate-specific antigen screening presented to a chiropractor with chronic, worsening radiating low back pain. In each case, a previous provider obtained radiographs and ascribed symptoms to a non-cancerous etiology (i.e., lumbar spondylosis, osteoporotic compression fracture), treated with nonsteroidal anti-inflammatory medications and physiotherapy. Given each patient's progressive worsening and neurologic deficits, the chiropractor ordered lumbar magnetic resonance imaging, revealing potential spinal metastasis. The chiropractor referred each patient to an oncologist who performed additional testing, making a presumptive diagnosis of prostate cancer. A literature review identified seven cases of previously undiagnosed prostate cancer presenting to a chiropractor. Including the current cases, patients were often older, presenting with thoracolumbar pain caused by spine or pelvic metastasis. The current cases and literature review illustrate that men with undiagnosed metastasis from prostate cancer may present to chiropractors complaining of spinal pain. Chiropractors should be aware of red flags warranting imaging such as older age and new or progressive symptoms and should refer patients to an oncologist when suspecting prostate cancer.