Bhindi Amar, Bhindi Bimal, Kulkarni Girish S, Hamilton Robert J, Toi Ants, van der Kwast Theodorus H, Evans Andrew, Zlotta Alexandre R, Finelli Antonio, Fleshner Neil E
Department of Medicine, McGill University, Montreal, QC, Canada.
Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.
Can Urol Assoc J. 2017 Jan-Feb;11(1-2):41-46. doi: 10.5489/cuaj.4031.
We sought to determine if prostate cancer (PCa) is associated with worse lower urinary tract symptoms (LUTS) than matched benign prostates, with attention to cancer characteristics, in a contemporary cohort.
Using a single-institution database (January 1, 2009-June 30, 2013), men diagnosed with PCa on biopsy and controls with negative biopsies were matched 1:1 on age, prostate volume, and a propensity score predicting the probability of PCa diagnosis. International Prostate Symptom Score (IPSS) was compared between PCa cases and controls using paired statistics, stratifying on grade, cancer volume, stage, and D'Amico risk group. Sensitivity analyses were performed separately, repeating the match for high-grade, high-volume, and high-stage cancers only, and excluding users of benign prostatic hyperplasia medications.
In our cohort of 1330 men (665 with PCa), there were 284 (42.7%) Gleason 6 cancers (Grade Group 1), 315 (47.4%) Gleason 7 cancers (Grade Group 2-3), and 66 (9.9%) Gleason 8-10 cancers (Grade Group 4-5). There was no difference in IPSS between PCa cases (median 6.5, interquartile range [IQR] 3-12) and benign controls (median 7, IQR 3-13; p=0.34). Subgroup analyses based on cancer grade, volume, or stage, showed no significant differences in IPSS between men with and without PCa, except among men with cT2b-cT4 PC (median 9, IQR 5-16) vs. matched benign counterparts (median 8, IQR 3-12; p=0.03). Sensitivity analyses supported these findings.
Modern PCa does not appear to be associated with worse LUTS compared to benign prostates of the same size. Outlet obstruction is likely a late event in the natural history of PCa. This has implications for timely PCa detection, which should ideally be prior to the onset of LUTS.
我们试图确定在一个当代队列中，前列腺癌（PCa）与匹配的良性前列腺相比，是否会导致更严重的下尿路症状（LUTS），同时关注癌症特征。
利用一个单机构数据库（2009年1月1日至2013年6月30日），对经活检诊断为PCa的男性和活检阴性的对照者按年龄、前列腺体积以及预测PCa诊断概率的倾向评分进行1:1匹配。使用配对统计方法比较PCa病例组和对照组的国际前列腺症状评分（IPSS），并按分级、癌体积、分期和达米科风险组进行分层。分别进行敏感性分析，仅对高级别、大体积和高分期癌症重复匹配，并排除良性前列腺增生药物使用者。
在我们的1330名男性队列中（665例PCa患者），有284例（42.7%）Gleason 6级癌症（1级组），315例（47.4%）Gleason 7级癌症（2 - 3级组），66例（9.9%）Gleason 8 - 10级癌症（4 - 5级组）。PCa病例组（中位数6.5，四分位间距[IQR] 3 - 12）和良性对照组（中位数7，IQR 3 - 13；p = 0.34）的IPSS无差异。基于癌症分级、体积或分期的亚组分析显示，有和没有PCa的男性之间IPSS无显著差异，但cT2b - cT4期PCa男性（中位数9，IQR 5 - 16）与匹配的良性对照者（中位数8，IQR 3 - 12；p = 0.03）相比除外。敏感性分析支持这些发现。
与相同大小的良性前列腺相比，现代PCa似乎不会导致更严重的LUTS。出口梗阻可能是PCa自然病程中的晚期事件。这对及时检测PCa具有重要意义，理想情况下应在LUTS出现之前进行检测。
