OBJECTIVE: To investigate the association between lower urinary tract symptoms status and prostate cancer risk at initial extended biopsy.
METHODS: Between 2005 and 2011, the International Prostate Symptom Score was completed on 1467 consecutive men with prostate-specific antigen < 10 ng/mL and non-suspicious digital rectal examination. After excluding 308 men treated with alpha-blockers, the remaining 1159 men were enrolled in the present study. Lower urinary tract symptoms status was divided into absent or mild (International Prostate Symptom Score scores of 0-7) and moderate or severe lower urinary tract symptoms (International Prostate Symptom Score scores of 8-35). The risks of prostate cancer diagnosis and high-grade (Gleason score ≥4 + 3) prostate cancer diagnosis in relation to lower urinary tract symptoms status was evaluated using logistic regression. A stratified analysis based on prostate volume (< 30 cc, 30-50 cc and >50 cc) was also carried out.
RESULTS: Of 1159 patients, 421 (36.3%) had a positive biopsy and 590 (51.0%) had moderate or severe lower urinary tract symptoms. On multivariate analysis, absent or mild lower urinary tract symptoms had a significant and positive impact on the risk of prostate cancer and high-grade disease (odds ratio 1.64 and 1.70, P = 0.0007 and 0.0121, respectively). Furthermore, the aforementioned findings for prostate cancer detection did not change throughout every prostate volume subgroup. In contrast, in men with prostate volume ≤ 50 cc, but not in those with prostate volume >50 cc, prostate-specific antigen or %free prostate-specific antigen remained as a significant predictor of prostate cancer.
CONCLUSION: In men with elevated prostate-specific antigen, absent or mild lower urinary tract symptoms are positively associated with prostate cancer and high-grade disease regardless of the prostate volume. This finding is especially useful in men with enlarged prostates.
Written by:
Ito M, Masuda H, Kawakami S, Fujii Y, Koga F, Saito K, Yamamoto S, Yonese J, Fukui I, Kihara K. Are you the author?
Department of Urology, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan.
Reference: Int J Urol. 2013 Mar 21. Epub ahead of print.
doi: 10.1111/iju.12141
PubMed Abstract
PMID: 23521022
UroToday.com Prostate Cancer Section
