Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Urology, University of South Florida, Tampa, FL, USA.
Prostate Cancer Prostatic Dis. 2018 Jun;21(2):238-244. doi: 10.1038/s41391-018-0044-y. Epub 2018 May 23.
The relationship between baseline prostate-specific antigen (PSA) and development of lower urinary tract symptoms (LUTS) in asymptomatic and mildly symptomatic men is unclear. We sought to determine if PSA predicts incident LUTS in these men.
A post-hoc analysis of the 4-year REDUCE study was performed to assess for incident LUTS in 1534 men with mild to no LUTS at baseline. The primary aim was to determine whether PSA independently predicted incident LUTS after adjusting for the key clinical variables of age, prostate size, and baseline International prostate symptom score (IPSS). Incident LUTS was defined as the first report of medical treatment, surgery, or sustained clinically significant symptoms (two IPSS >14). Cox proportional hazards, cumulative incidence curves, and the log-rank test were used to test our hypothesis.
A total of 1534 men with baseline IPSS <8 were included in the study cohort. At baseline, there were 335 men with PSA 2.5-4 ng/mL, 589 with PSA 4.1-6 ng/mL, and 610 with PSA 6-10 ng/mL. During the 4-year study, 196 men progressed to incident LUTS (50.5% medical treatment, 9% surgery, and 40.5% new symptoms). As a continuous variable, higher PSA was associated with increased incident LUTS on univariable (HR 1.09, p = 0.019) and multivariable (HR 1.08, p = 0.040) analysis. Likewise, baseline PSA 6-10 ng/mL was associated with increased incident LUTS vs. PSA 2.5-4 ng/mL in adjusted models (HR 1.68, p = 0.016). This association was also observed in men with PSA 4.1-6 ng/mL vs. PSA 2.5-4 ng/mL (HR 1.60, p = 0.032).
Men with mild to no LUTS but increased baseline PSA are at increased risk of developing incident LUTS presumed due to benign prostatic hyperplasia.
在无症状和轻度症状男性中，基线前列腺特异性抗原（PSA）与下尿路症状（LUTS）发展之间的关系尚不清楚。我们旨在确定 PSA 是否可以预测这些男性的新发 LUTS。
对 4 年 REDUCE 研究进行了事后分析，以评估 1534 名基线时轻度至无症状的男性中是否存在新发 LUTS。主要目的是确定在调整年龄、前列腺大小和基线国际前列腺症状评分（IPSS）等关键临床变量后，PSA 是否可以独立预测新发 LUTS。新发 LUTS 的定义为首次报告接受药物治疗、手术或持续存在明显临床症状（IPSS 两次>14）。使用 Cox 比例风险、累积发生率曲线和对数秩检验来检验我们的假设。
共有 1534 名基线 IPSS<8 的男性被纳入研究队列。基线时，PSA 2.5-4ng/mL 组有 335 名男性，PSA 4.1-6ng/mL 组有 589 名男性，PSA 6-10ng/mL 组有 610 名男性。在 4 年的研究期间，有 196 名男性进展为新发 LUTS（50.5%药物治疗，9%手术，40.5%新症状）。作为连续变量，在单变量（HR 1.09，p=0.019）和多变量（HR 1.08，p=0.040）分析中，较高的 PSA 与新发 LUTS 相关。同样，与 PSA 2.5-4ng/mL 相比，基线 PSA 6-10ng/mL 与调整模型中新发 LUTS 的发生相关（HR 1.68，p=0.016）。在 PSA 4.1-6ng/mL 与 PSA 2.5-4ng/mL 相比的男性中也观察到了这种相关性（HR 1.60，p=0.032）。
基线时轻度至无症状但 PSA 升高的男性新发 LUTS 的风险增加，这可能归因于良性前列腺增生。
