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Impact of lower urinary tract symptoms on prostate cancer risk among J apanese men with prostate‐specific antigen <10 ng/mL and non‐suspicious digital rectal examination
Author(s) -
Ito Masaya,
Masuda Hitoshi,
Kawakami Satoru,
Fujii Yasuhisa,
Koga Fumitaka,
Saito Kazutaka,
Yamamoto Shinya,
Yonese Junji,
Fukui Iwao,
Kihara Kazunori
Publication year - 2013
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12141
Subject(s) - medicine , prostate cancer , lower urinary tract symptoms , rectal examination , prostate , urinary system , urology , prostate biopsy , international prostate symptom score , prostate specific antigen , odds ratio , cancer , gastroenterology
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 I nternational P rostate S ymptom S core 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 ( I nternational P rostate S ymptom S core scores of 0–7) and moderate or severe lower urinary tract symptoms ( I nternational P rostate S ymptom S core scores of 8–35). The risks of prostate cancer diagnosis and high‐grade ( G leason 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.