Lower urinary tract symptoms (LUTS) are not associated with an increased risk of prostate cancer in men 50–69 years with PSA ≥3 ng/ml

Background: There is conflicting evidence about the association between prostate cancer and Lower Urinary Tract Symptoms (LUTS). We aimed to describe the prevalence of LUTS and its association with prostate cancer risk.
Methods: We studied the association between International Prostate Symptom Score (IPSS) and prostate cancer in a population-based sample of men (n = 45,595) aged 50–69 years from the Stockholm3 study. Men with PSA ≥3 ng/ml (n = 4579) underwent systematic prostate biopsies. We used the International Society of Urological Pathology Gleason Grading (ISUP grade) and performed regression analysis for risk of any cancer (n = 1797), ISUP grade ≥2 (n = 840) and advanced cancer, defined as ISUP grade ≥3 or cT ≥3 (n = 353).
Results: 74.6% of all men had no or mild LUTS (IPSS ≤7) and 3.2% had severe LUTS (IPSS >19). Men with any, ISUP grade ≥2 or advanced cancer had lower median IPSS compared to men with benign biopsy (any cancer: 4 (IQR 2–9); ISUP grade ≥2: 4 (2–8); advanced cancer: 4 (2–8); benign biopsy: 6 (3–11); p < 0.05). IPSS was not associated with increased risk of cancer in multivariate analyses (OR (any cancer) 0.97; 95% CI 0.96–0.98; OR (ISUP grade ≥2) 0.97; 95% CI 0.96–0.99; OR (advanced cancer) 0.99; 95% CI 0.99–1.01).
Conclusions: Three-quarters of men aged 50–69 years report no or mild LUTS. Our data do not support any clinically meaningful association between LUTS and prostate cancer. Specifically, men with advanced prostate cancer did not exhibit more urinary symptoms than men without cancer.

背景：目前关于前列腺癌与下尿路症状（Lower Urinary Tract Symptoms, LUTS）之间的关联证据存在分歧。本研究旨在描述下尿路症状的患病率及其与前列腺癌发病风险的关联。
方法：本研究基于斯德哥尔摩3研究（Stockholm3 study）的人群样本，纳入45595名年龄在50~69岁的男性，分析国际前列腺症状评分（International Prostate Symptom Score, IPSS）与前列腺癌的关联。其中前列腺特异性抗原（Prostate Specific Antigen, PSA）≥3 ng/ml的4579名男性接受了系统性前列腺穿刺活检。本研究采用国际泌尿病理学会格里森分级（International Society of Urological Pathology Gleason Grading, ISUP分级），针对三类风险开展回归分析：任意前列腺癌（n=1797）、ISUP分级≥2级（n=840）以及定义为ISUP分级≥3级或临床T分期（cT）≥3期的进展期前列腺癌（n=353）。
结果：所有男性中74.6%无或仅存在轻度下尿路症状（IPSS≤7），3.2%存在重度下尿路症状（IPSS>19）。与良性活检组相比，任意前列腺癌患者、ISUP分级≥2级患者及进展期前列腺癌患者的IPSS中位数更低：任意前列腺癌组为4（四分位数间距（Interquartile Range, IQR）2~9），ISUP分级≥2级组为4（2~8），进展期前列腺癌组为4（2~8），良性活检组为6（3~11），组间差异具有统计学意义（p<0.05）。多因素分析显示，IPSS与前列腺癌发病风险升高无显著关联：任意前列腺癌的比值比（Odds Ratio, OR）为0.97，95%置信区间（95% Confidence Interval, 95% CI）为0.96~0.98；ISUP分级≥2级前列腺癌的OR为0.97，95% CI为0.96~0.99；进展期前列腺癌的OR为0.99，95% CI为0.99~1.01。
结论：50~69岁男性中约四分之三自述无或仅存在轻度下尿路症状。本研究数据不支持下尿路症状与前列腺癌之间存在具有临床意义的关联。具体而言，进展期前列腺癌患者的尿路症状并不比无癌男性更多。