Collin Simon M, Metcalfe Chris, Donovan Jenny, Lane J Athene, Davis Michael, Neal David, Hamdy Freddie, Martin Richard M
Department of Social Medicine, University of Bristol, Bristol, UK.
BJU Int. 2008 Nov;102(10):1400-6. doi: 10.1111/j.1464-410X.2008.07817.x. Epub 2008 Jun 6.
To determine associations of lower urinary tract symptoms (LUTS) with prostate-specific antigen (PSA) levels and screen-detected localized and advanced prostate cancer.
A case-control study nested within the UK population-based ProtecT (Prostate testing for cancer and Treatment) study. Men aged 50-69 years were invited for PSA testing and those with a PSA level of >or=3.0 ng/mL were invited for biopsy. We determined whether LUTS were associated with a PSA level of >or=3.0 ng/mL and prostate cancer using logistic regression models adjusted for age, family history of prostate cancer and PSA level as appropriate. Areas under receiver operating characteristic curves (AUC) were compared between models with and without symptoms.
In all, 65 871 men had a PSA test: 7251 had a PSA level of >or=3.0 ng/mL including 2467 subsequently diagnosed with prostate cancer (2119 localized, 348 advanced). LUTS were positively associated with a PSA level of >or=3.0 ng/mL: odds ratios (ORs) were 1.18 (95% confidence interval, CI 1.01-1.38), 1.69 (95% CI 1.32-2.16), and 1.60 (95% CI 1.33-1.93) for daytime urination frequency (hourly vs less frequent), urgency and hesitancy (most/all the time vs never), respectively. LUTS among men with a PSA level of >or=3 ng/mL were negatively associated with prostate cancer: ORs were 0.44 (95% CI 0.22-0.83), 0.74 (95% CI 0.63-0.87), and 0.83 (95% CI 0.73-0.94) for nocturia (4+ vs 0), leakage and hesitancy (occasionally/sometimes vs never), respectively. LUTS improved the prediction of a PSA level of >or=3.0 ng/mL (AUC 0.635 vs 0.606, P < 0.001) and prostate cancer (AUC 0.661 vs 0.638; P < 0.001).
A history of LUTS before PSA testing marginally improves the prediction of an individual's risk for prostate cancer; men with a PSA level of >or=3 ng/mL and LUTS were more likely to be diagnosed with benign disease than prostate cancer.
确定下尿路症状（LUTS）与前列腺特异性抗原（PSA）水平以及筛查发现的局限性和晚期前列腺癌之间的关联。
一项巢式病例对照研究，纳入基于英国人群的ProtecT（前列腺癌检测与治疗）研究。邀请年龄在50 - 69岁的男性进行PSA检测，PSA水平≥3.0 ng/mL的男性被邀请进行活检。我们使用根据年龄、前列腺癌家族史和PSA水平进行适当调整的逻辑回归模型，确定LUTS是否与PSA水平≥3.0 ng/mL及前列腺癌相关。比较有症状和无症状模型的受试者工作特征曲线下面积（AUC）。
共有65871名男性进行了PSA检测：7251名男性PSA水平≥3.0 ng/mL，其中2467名随后被诊断为前列腺癌（2119例局限性癌，348例晚期癌）。LUTS与PSA水平≥3.0 ng/mL呈正相关：白天排尿频率（每小时排尿与较少排尿）、尿急和排尿犹豫（大多数/全部时间与从不）的优势比（OR）分别为1.18（95%置信区间，CI 1.01 - 1.38）、1.69（95% CI 1.32 - 2.16）和1.60（95% CI 1.33 - 1.93）。PSA水平≥3 ng/mL男性中的LUTS与前列腺癌呈负相关：夜尿（4次及以上与0次）、漏尿和排尿犹豫（偶尔/有时与从不）的OR分别为0.44（95% CI 0.22 - 0.83）、0.74（95% CI 0.63 - 0.87）和0.83（95% CI 0.73 - 0.94）。LUTS改善了对PSA水平≥3.0 ng/mL（AUC 0.635对0.606，P < 0.001）和前列腺癌（AUC 0.661对0.638；P < 0.001）的预测。
PSA检测前有LUTS病史可略微改善对个体前列腺癌风险的预测；PSA水平≥3 ng/mL且有LUTS的男性被诊断为良性疾病而非前列腺癌的可能性更大。
