title: Presence and severity of lower urinary tract symptoms are inversely correlated with the risk of prostate cancer on prostate biopsy.
abstract: BACKGROUND
  The assessment of lower urinary tract symptoms (LUTS) is common part of urological investigation. Furthermore, patients bother of prostate cancer (PCa) when they are affected of LUTS. This study was aimed to determine whether the presence and severity of LUTS, as assessed by the International Prostate Symptoms Score (IPSS), could help to identify patients at higher risk of prostate cancer (PCa) on prostate biopsy (PBx). In this effort, an initial PCa predictive model was calculated and IPSS was subsequently added. The diagnostic accuracy of both models was compared.
  
  
  METHODS
  The analysis of prospectively collected data of patients scheduled for PBx at four academic hospitals between January 2012 and June 2015 was performed. Univariate and multivariate analysis assessed the correlation between the IPSS and the risk of being diagnosed with PCa; Receiver operator characteristic curve (ROC) analysis evaluated the predictive models including or not the IPSS.
  
  
  RESULTS
  Of the 1366 enrolled patients, 706 (52%) were diagnosed with PCa. Patients with PCa had a significantly lower IPSS (10.6±7.4 vs. 12.7±8.1) than those with benign diagnosis. Multivariate logistic regression analysis showed that age, prostate-specific antigen (PSA), prostate volume and IPSS were the most significant predictors of PBx outcome, (OR 1.61, P=0.001; OR 1.20, P=0.001; OR 0.97, P=0.001; OR 0.74, P=0.004; respectively). ROC curve analysis showed that the addition of IPSS to the predictive model based on age, PSA, DRE and prostate volume significantly improved the model diagnostic accuracy (AUC: 0.776 vs. 0.652; P=0.001).
  
  
  CONCLUSIONS
  Presence and severity of LUTS are inversely correlated with the risk of being diagnosed with PCa at PBx. Incorporating the IPSS into predictive models may reduce the risk of unnecessary PBxs.
authors.affiliation: Unit of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy - acicione@libero.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cicione
authors.affiliation: Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Cormio
authors.affiliation: Unit of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cantiello
authors.affiliation: Unit of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy.
authors.forename: Italo M
authors.initials: IM
authors.lastname: Palumbo
authors.affiliation: Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: Cosimo
authors.initials: C
authors.lastname: DE Nunzio
authors.affiliation: Life and Health Sciences Research Institute, University of Minho, Braga, Portugal.
authors.forename: Estevao
authors.initials: E
authors.lastname: Lima
authors.affiliation: Unit of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ucciero
authors.affiliation: Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Carrieri
authors.affiliation: Unit of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Damiano
mesh_terms: D000368:Aged; D001706:Biopsy; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D012306:Risk
chemical_list: D017430:Prostate-Specific Antigen