Modern-day prostate cancer is not meaningfully associated with lower urinary tract symptoms: Analysis of a propensity scorematched cohort

Bhindi, Amar; Bhindi, Bimal; Kulkarni, Girish S.; Hamilton, Robert J.; Toi, Ants; Kwast, Theodorus H. van der; Evans, Andrew; Zlotta, Alexandre R.; Finelli, Antonio; Fleshner, Neil

doi:10.5489/cuaj.4031

Cited by 12 publications

(13 citation statements)

References 27 publications

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“…LUTS are generally associated with possible prostate cancer by clinicians and patients alike, although there is no strong evidence for this [ 4 ]. Studies have found an increased risk of localised prostate cancer in men with LUTS, but no association between LUTS and advanced prostate cancer [ 20 – 22 ]. It is thought that patients presenting to their doctor with LUTS are at higher risk of being diagnosed with prostate cancer as a result of higher rates of testing, and are mainly diagnosed with early stage prostate cancer which may or may not affect their long-term mortality risk [ 21 ].…”

Section: Symptoms and Signsmentioning

confidence: 99%

Prostate Cancer in Primary Care

2018

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Prostate cancer is a common malignancy seen worldwide. The incidence has risen in recent decades, mainly fuelled by more widespread use of prostate-specific antigen (PSA) testing, although prostate cancer mortality rates have remained relatively static over that time period. A man’s risk of prostate cancer is affected by his age and family history of the disease. Men with prostate cancer generally present symptomatically in primary care settings, although some diagnoses are made in asymptomatic men undergoing opportunistic PSA screening. Symptoms traditionally thought to correlate with prostate cancer include lower urinary tract symptoms (LUTS), such as nocturia and poor urinary stream, erectile dysfunction and visible haematuria. However, there is significant crossover in symptoms between prostate cancer and benign conditions affecting the prostate such as benign prostatic hypertrophy (BPH) and prostatitis, making it very challenging to distinguish between them on the basis of symptoms. The evidence for the performance of PSA in asymptomatic and symptomatic men for the diagnosis of prostate cancer is equivocal. PSA is subject to false positive and false negative results, affecting its clinical utility as a standalone test. Clinicians need to counsel men about the risks and benefits of PSA testing to inform their decision-making. Digital rectal examination (DRE) by primary care clinicians has some evidence to show discrimination between benign and malignant conditions affecting the prostate. Patients referred to secondary care for diagnostic testing for prostate cancer will typically undergo a transrectal or transperineal biopsy, where a number of samples are taken and sent for histological examination. These biopsies are invasive procedures with side effects and a risk of infection and sepsis, and alternative tests such as multiparametric magnetic resonance imaging (mpMRI) are currently being trialled for their accuracy and safety in diagnosing clinically significant prostate cancer.

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Section: Symptoms and Signsmentioning

confidence: 99%

Prostate Cancer in Primary Care

2018

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“…Earlier evidence on the association between LUTS and prostate cancer are conflicting, as some studies have argued that there is a positive correlation between LUTS and prostate cancer [4,5], and some that there is not [8,9]. The Prostate Cancer Prevention Trial (PCPT) [27], showed no positive association between BPH and prostate cancer [9].…”

Section: Discussionmentioning

confidence: 99%

“…and prostate volumes. The medians differed less than 0.5%.The distribution of IPSS in this population-based sample of men aged 50-69 is shown inFigure 1: 33,995 (74.6%) men had low IPSS (0-7), 10,128 (22.8%) medium IPSS(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) and 1472 (3.2%) high IPSS (20-35). More than a third (38%, n ¼ 17,603) had no or very few symptoms (IPSS 0-2) and 25% (n ¼ 11,621) had IPSS 3-5.…”

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confidence: 85%

“…Each question renders 0-5 points depending on the severity of the symptom, thus a total of 35 points can be obtained. The total score is categorized as low, medium or high and can then be used to grade LUTS as mild (IPSS 0-7 points), moderate (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) or severe (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35).…”

Section: Methodsmentioning

confidence: 99%

“…The relationship between prostate cancer, BPH and LUTS has been studied in various settings [4][5][6][7][8][9][10][11]. However, these studies have mostly been conducted on observational data and are prone to ascertainment bias.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Pálsdóttir

Aly

et al. 2019

Scandinavian Journal of Urology

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Impact of radical prostatectomy on bladder function as demonstrated on urodynamics study—A systematic review

Yao

Hoe

Crump

et al. 2021

Neurourology and Urodynamics

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Aims: This study aims to describe the effects of radical prostatectomy (RP) on bladder function by performing a systematic review of urodynamics study findings before and after RP. Methods: This systematic review was conducted in accordance with the PRISMA guideline and registered on PROSPERO (CRD42020206844). A systematic search was conducted using PubMed, Cochrane, and Embase. Studies were included if they involved men who underwent RP and had urodynamics study performed preoperatively, postoperatively, or both. Studies that included only subgroups of patients based on symptoms were excluded. Three hundred and four articles were screened, with 20 articles included. A qualitative analysis was performed. Results: The rate of baseline bladder outlet obstruction (BOO) pre-RP was 19%-67%. All six studies with comparative data pre-and postoperatively demonstrated a decrease in the rate of patients with equivocal or clear obstruction. The baseline rates of detrusor overactivity (DO) varied widely from 11% to 61.2%. Six of eight studies with 6 months or more follow-up showed an improvement in the rates of DO ranging from 3.0% to 12.5%. The rate of de novo DO ranged from 0% to 54.5%. Four studies reported an increased rate of impaired bladder contractility and two of three studies showed a worsening rate of impaired bladder compliance following RP. This review is limited by the absence of level I/II studies. Conclusions: Urodynamics study shows that BOO is improved following RP in most patients. RP resolves DO in some patients and cause de novo DO in others. The net effect is a reduced overall rate of DO in most studies. Bladder compliance and contractility may be impaired after RP.

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Modern-day prostate cancer is not meaningfully associated with lower urinary tract symptoms: Analysis of a propensity scorematched cohort

Abstract: Introduction: We sought to determine if prostate cancer (PCa) is associated with worse lower urinary tract symptoms (LUTS) than matched benign prostates, with attention to cancer characteristics, in a contemporary cohort. Methods: Using a single-institution database

Cited by 12 publications

References 27 publications

Prostate Cancer in Primary Care

Prostate Cancer in Primary Care

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

Impact of radical prostatectomy on bladder function as demonstrated on urodynamics study—A systematic review

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