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

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


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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