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

Authors

  • Amar Bhindi Department of Medicine, McGill University, Montreal, Quebec, Canada
  • Bimal Bhindi Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
  • Girish S. Kulkarni Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
  • Robert J. Hamilton Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
  • Ants Toi Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
  • Theodorus H. van der Kwast Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada
  • Andrew Evans Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada
  • Alexandre R. Zlotta Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
  • Antonio Finelli Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
  • Neil E. Fleshner Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada

DOI:

https://doi.org/10.5489/cuaj.4031

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 (January 1, 2009‒ June 30, 2013), men diagnosed with PCa on biopsy and controls with negative biopsies were matched 1:1 on age, prostate volume, and a propensity score predicting the probability of PCa diagnosis. International Prostate Symptom Score (IPSS) was compared between PCa cases and controls using paired statistics, stratifying on grade, cancer volume, stage, and D’Amico risk group. Sensitivity analyses were performed separately, repeating the match for highgrade, high-volume, and high-stage cancers only, and excluding users of benign prostatic hyperplasia medications.

Results: In our cohort of 1330 men (665 with PCa), there were 284 (42.7%) Gleason 6 cancers (Grade Group 1), 315 (47.4%) Gleason 7 cancers (Grade Group 2‒3), and 66 (9.9%) Gleason 8‒10 cancers (Grade Group 4‒5). There was no difference in IPSS between PCa cases (median 6.5, interquartile range [IQR] 3‒12) and benign controls (median 7, IQR 3‒13; p=0.34). Subgroup analyses based on cancer grade, volume, or stage, showed no significant differences in IPSS between men with and without PCa, except among men with cT2b-cT4 PC (median 9, IQR 5‒16) vs. matched benign counterparts (median 8, IQR 3‒12; p=0.03). Sensitivity analyses supported these findings.

Conclusions: Modern PCa does not appear to be associated with worse LUTS compared to benign prostates of the same size. Outlet obstruction is likely a late event in the natural history of PCa. This has implications for timely PCa detection, which should ideally be prior to the onset of LUTS.

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Published

2017-02-20

How to Cite

Bhindi, A., Bhindi, B., Kulkarni, G. S., Hamilton, R. J., Toi, A., van der Kwast, T. H., Evans, A., Zlotta, A. R., Finelli, A., & Fleshner, N. E. (2017). Modern-day prostate cancer is not meaningfully associated with lower urinary tract symptoms: Analysis of a propensity scorematched cohort. Canadian Urological Association Journal, 11(1-2), 41–6. https://doi.org/10.5489/cuaj.4031

Issue

Section

Original Research