LUTS May Indicate Lower PCa Risk

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VIENNA—Lower urinary tract symptoms (LUTS) in men may provide useful information about the risk of having prostate cancer (PCa) diagnosed, data from two studies presented at the 26th Annual Congress of the European Association of Urology.

In one study, Swedish investigators found that men with an elevated PSA level (3.0 ng/mL or higher) and any degree of LUTS are less likely to be diagnosed with PCa. In the other study, researchers in The Netherlands showed that moderate to severe LUTS predicted a decreased risk of a PCa diagnosis compared with men who had mild or no LUTS.

Concern that LUTS could be caused by PCa frequently prompts clinicians to order PSA tests, both research teams noted.

The Swedish study, by Maria Frånlund, MD, and collaborators at the Institute of Clinical Sciences in Gothenburg, Sweden, examined data from the Gothenburg randomized population-based PCa screening trial, which was initiated in 1995. Researchers randomly selected 20,000 men born between 1930 and 1944 to be in a screening group or a control group. The 10,000 men in the screening group were invited to have PSA tests every two years and the 10,000 men in the control group were not invited to have PSA tests.

In 2,590 men, their PSA level was elevated at least once during the study period (3.0 or higher). Of these, 2,353 (91%) accepted further assessment with transrectal ultrasound-guided prostate biopsies. Patients were given self-administered questionnaires that included questions about voiding symptoms. Men who had any degree of LUTS were considered to have LUTS. The cohort had a median age of 63.3 years, a median PSA level of 3.8, and a median prostate volume of 37.8 cc. padding=
Maria Frånlund, MD

Of the 2,353 men, 633 (27%) had PCa and 1,720 had benign outcomes. Men who reported LUTS had a significantly lower frequency of PCa than those who did not (24% vs. 31%). The researchers concluded that LUTS in men with elevated PSA is inversely related to the risk of PCa. “The presence of urinary symptoms could therefore be a factor worth considering when evaluating the indication for prostate biopsies,” said Dr. Frånlund, who presented study findings.

In the second study, Monique Roobol, PhD, an epidemiologist in the Department of Urology at Erasmus University Medical Center in Rotterdam, and colleagues analyzed data from 3,647 men who participated in the initial PSA screening round as part of the European Randomised Study of Screening for Prostate Cancer. Subjects had complete data on International Prostate Symptom Score (IPSS) and underwent sextant prostate biopsies on the basis of elevated PSA (4.0 or higher) and/or abnormal digital rectal examination (1993-1997) or a PSA value of 3.0 or higher (1997-2000). Dr. Roobol's group assessed the number of PCa cases identified as a result of the first screening and after 12 years of follow-up.
Monique Roobol, PhD

At the initial screening, the PCa detection rate was highest among men with mild or no LUTS compared with men with moderate or severe LUTS (26.3% vs. 21.5% and 21.0%, respectively). A higher detection rate for those with mild or no LUTS also was evident after 12 years of follow-up (36.1% vs. 29.1% and 27.3%). After adjusting for age and PSA at initial screening, moderate and severe LUTS was associated with a 23% and 32% decreased risk of a PCa diagnosis, respectively.

Dr. Roobol and her colleagues acknowledged that men with moderate or severe LUTS in general have larger prostates, so sextant biopsies might have been more likely to miss tumors in these men.

“PSA testing simply on the basis of the presence of moderate or severe LUTS is not justified,” Dr. Roobol said, adding that this can lead to unnecessary biopsies as well as miss finding PCa in men with mild or no LUTS.

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