title: Impact of lower urinary tract symptoms on prostate cancer risk among Japanese men with prostate-specific antigen <10 ng/mL and non-suspicious digital rectal examination.
abstract: 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 International Prostate Symptom Score 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 (International Prostate Symptom Score scores of 0-7) and moderate or severe lower urinary tract symptoms (International Prostate Symptom Score scores of 8-35). The risks of prostate cancer diagnosis and high-grade (Gleason 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Ito
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Masuda
authors.forename: Satoru
authors.initials: S
authors.lastname: Kawakami
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Fujii
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Koga
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Saito
authors.forename: Shinya
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Junji
authors.initials: J
authors.lastname: Yonese
authors.forename: Iwao
authors.initials: I
authors.lastname: Fukui
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kihara
mesh_terms: D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D001706:Biopsy; D015331:Cohort Studies; D051517:Digital Rectal Examination; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007610:Kallikreins / Q000097:blood*; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000453:epidemiology* / Q000473:pathology; D012307:Risk Factors
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: alpha-blocker; international prostate symptom score; lower urinary tract symptoms; prostate cancer; prostate volume