Lower urinary tract symptoms (LUTS) are not associated with an increased risk of prostate cancer in men 50–69 years with PSA ≥3 ng/ml

Engel, Jan Chandra; Pálsdóttir, Þorgerður; Aly, Markus; Egevad, Lars; Grönberg, Henrik; Eklund, Martin; Nordström, Tobias

doi:10.1080/21681805.2019.1703806

Cited by 17 publications

(10 citation statements)

References 25 publications

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“…LUTS and BPH are relatively common and their prevalence increases with age 26 . BPH is a common cause of LUTS and often coexists with PCa, 27 and men with LUTS preferred to be tested for PCa 28 . Several studies have examined the relationship between PCa, BPH, and LUTS 29–33 ; however, no consensus on the relationship between LUTS and the risk of PCa has yet been reached.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a predictive model for determining clinically significant prostate cancer in men with negative magnetic resonance imaging after transrectal ultrasound‐guided prostate biopsy

et al. 2021

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Background The interpretation of negative magnetic resonance imaging (MRI) screening results for clinically significant prostate cancer (csPCa) (International Society of Urological Pathology grade ≥group 2) is debatable and poses a clinical dilemma for urologists. No nomograms have been developed to predict csPCa in such populations. In this study, we aimed to develop and validate a model for predicting the probability of csPCa in men with negative MRI (PI‐RADS score 1–2) results after transrectal ultrasound‐guided systematic prostate biopsy. Methods The development cohort consisted of 728 patients with negative MRI results who underwent subsequent prostate biopsy at our center between January 1, 2014 and December 31, 2017. The patients' clinicopathologic data were recorded. The Lasso regression was used for data dimension reduction and feature selection, then multivariable binary logistic regression was used to build a predictive model with regression coefficients. The model was validated in an independent cohort of 334 consecutive patients from January 1, 2018 and June 30, 2020. The performance of the predictive model was assessed with respect to discrimination, calibration, and decision curve analysis. Results The predictors incorporated in this model included age, history of previous negative prostate biopsy, prostate specific antigen density (PSAD), and lower urinary tract symptoms, with PSAD being the strongest predictor. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.875 (95% confidence interval, 0.816–0.933) and good calibration (unreliability test, p = .540). Decision curve analysis demonstrated that the model was clinically useful. Conclusion This study presents a good nomogram that can aid pre‐biopsy risk stratification for the detection of csPCa, and that may help inform biopsy decisions in patients with negative MRI results.

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Section: Discussionmentioning

confidence: 99%

Development and validation of a predictive model for determining clinically significant prostate cancer in men with negative magnetic resonance imaging after transrectal ultrasound‐guided prostate biopsy

et al. 2021

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“…Several medical societies recommend PSA testing in patients with LUTS to check for PCa [ 12 , 25 ], although the benefit-to-harm ratio of PSA testing in these patients is unclear [ 26 ]. Some findings show a relationship between LUTS and PCa but only for localized cancer [ 27 ], while others do not [ 28 , 29 ]. Moreover, symptoms were not associated with PCa-specific mortality [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Do the Prostate-Specific Antigen (PSA) Tests That Are Ordered in Clinical Practice Adhere to the Pertinent Guidelines?

Bernal-Soriano

Parker

López-Garrigós

et al. 2021

JCM

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Scientific societies have provided guidelines to reduce PSA-specific harms. We studied the potential non-compliance of PSA testing with current guidelines in general practice. A cross-sectional study of a random sample of 1291 patients with a PSA test was performed between January and April 2018 in primary health care. Patients with a previous prostate cancer diagnosis or those who were being followed-up for previous high PSA values were excluded. Two independent researchers classified whether each test was potentially non-compliant with recommendations. We estimated frequencies of potentially non-compliant PSA determinations and calculated prevalence ratios (PR) to assess their relationship with possible explanatory variables. A total of 66% (95% CI: 62–69%) of PSA requests in asymptomatic patients were potentially non-compliant with the current guideline. This was associated with having a previous diagnosis of neoplasm (PR adjusted by age and life expectancy: 1.18; 95% CI: 1.02–1.37) as well as being a current consumer of tobacco, alcohol, or other drugs (PR: 0.80; 95% CI: 0.67–0.97). Real world data shows that patients are still frequently exposed to overdiagnosis risk with a PSA potentially non-compliant with recommendations. Patients diagnosed with another neoplasm or non-consumers of toxic substances were more exposed, probably due to increased contact with doctors or health-seeking behaviour.

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“…Our assumption that patients with LUTS will be diagnosed earlier than asymptomatic patients with serendipitously elevated PSA was not proven in our study. The most probable explanation is that PCa usually arises in the peripheral zone and does not affect urinary tract obstruction and therefore does not cause symptoms [ 18 ]. Therefore, it is not correct to simply assume that people with lower urinary tract symptoms will get PSA tests earlier and have cancer detected earlier.…”

Section: Discussionmentioning

confidence: 99%

The presence of prostate-specific antigen checked more than 1 year before diagnostic biopsy is an independent prognostic factor in patients undergoing radical prostatectomy

et al. 2021

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Purpose In large scale prospective studies, prostate-specific antigen (PSA)-screening not only decreased prostate cancer mortality, but also reduced biochemical recurrence (BCR) in patients undergoing radical prostatectomy (RP). We investigated the independent effect of the presence of PSA checked more than 1 year before diagnostic biopsy on the prognosis of patients undergoing RP in a real world setting without PSA-screening. Materials and Methods We reviewed the database of patients undergoing RP at Ajou University Hospital from March 1999 to May 2018. Clinicopathological features assessed were age, presence of lower urinary tract symptoms at presentation, presence of PSA checked over 1 year before biopsy, presence of PSA checked within 4 to 1 years of biopsy, last pre-biopsy PSA (pPSA), biopsy grade group (bGG), cT, cN, percentage of positive biopsy cores (PPBC), pathological GG (pGG), pT, pN, surgical margin, and index tumor diameter. The primary endpoint was BCR-free survival (BCRFS). Results Of 598 patients enrolled, 211 experienced BCR at the mean follow-up of 64±37 months. The 5-year and 10-year BCRFS were 62.8% and 53.9%, respectively. In multivariate analyses including clinical variables only, pPSA, bGG, cT, PPBC, and PSA within 4 to 1 years of biopsy independently affected BCRFS. In multivariate analyses including pathological variables only, pPSA, pGG, pT, pN, PSA checked over 1 year before biopsy and PSA checked within 4 to 1 years of biopsy independently affected BCRFS. Conclusions Patients who has checked PSA at least once beyond 1 year before diagnosis of prostate cancer show better BCRFS regardless of other factors.

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Lower urinary tract symptoms (LUTS) are not associated with an increased risk of prostate cancer in men 50–69 years with PSA ≥3 ng/ml

Abstract: Nordström (2020) Lower urinary tract symptoms (LUTS) are not associated with an increased risk of prostate cancer in men 50-69 years with PSA ≥3 ng/ml,

Cited by 17 publications

References 25 publications

Development and validation of a predictive model for determining clinically significant prostate cancer in men with negative magnetic resonance imaging after transrectal ultrasound‐guided prostate biopsy

Development and validation of a predictive model for determining clinically significant prostate cancer in men with negative magnetic resonance imaging after transrectal ultrasound‐guided prostate biopsy

Do the Prostate-Specific Antigen (PSA) Tests That Are Ordered in Clinical Practice Adhere to the Pertinent Guidelines?

The presence of prostate-specific antigen checked more than 1 year before diagnostic biopsy is an independent prognostic factor in patients undergoing radical prostatectomy

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