Abstract
Background
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.
Methods
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.
Results
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).
Conclusions
Men with mild to no LUTS but increased baseline PSA are at increased risk of developing incident LUTS presumed due to benign prostatic hyperplasia.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 4 print issues and online access
$259.00 per year
only $64.75 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Parsons JK, Schenk JM, Arnold KB, Messer K, Till C, Thompson IM, et al. Finasteride reduces the risk of incident clinical benign prostatic hyperplasia. Eur Urol. 2012;62:234–41.
Engstrom G, Henningsohn L, Steineck G, Leppert J. Self-assessed health, sadness and happiness in relation to the total burden of symptoms from the lower urinary tract. BJU Int. 2005;95:810–5.
Taylor BC, Wilt TJ, Fink HA, Lambert LC, Marshall LM, Hoffman AR, et al. Prevalence, severity, and health correlates of lower urinary tract symptoms among older men: the MrOS study. Urology. 2006;68:804–9.
Emberton M, Cornel EB, Bassi PF, Fourcade RO, Gomez JM, Castro R. Benign prostatic hyperplasia as a progressive disease: a guide to the risk factors and options for medical management. Int J Clin Pract. 2008;62:1076–86.
Anderson JB, Roehrborn CG, Schalken JA, Emberton M. The progression of benign prostatic hyperplasia: examining the evidence and determining the risk. Eur Urol. 2001;39:390–9.
Bohnen AM,Groeneveld FP,Bosch JL, Serum prostate-specific antigen as a predictor of prostate volume in the community: the Krimpen study. Eur Urol. 2007;51:1645–52.
Roehrborn CG, Boyle P, Gould AL, Waldstreicher J. Serum prostate-specific antigen as a predictor of prostate volume in men with benign prostatic hyperplasia. Urology. 1999;53:581–9.
Roehrborn CG, McConnell J, Bonilla J, Rosenblatt S, Hudson PB, Malek GH, et al. Serum prostate specific antigen is a strong predictor of future prostate growth in men with benign prostatic hyperplasia. PROSCAR long-term efficacy and safety study. J Urol. 2000;163:13–20.
Roehrborn CG, McConnell JD, Lieber M, Kaplan S, Geller J, Malek GH, et al. Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia. PLESS Study Group. Urology. 1999;53:473–80.
Kok ET, Schouten BW, Bohnen AM, Groeneveld FP, Thomas S, Bosch JL. Risk factors for lower urinary tract symptoms suggestive of benign prostatic hyperplasia in a community based population of healthy aging men: the Krimpen study. J Urol. 2009;181:710–6.
Carter HB, Landis P, Wright EJ, Parsons JK, Metter EJ. Can a baseline prostate specific antigen level identify men who will have lower urinary tract symptoms later in life? J Urol. 2005;173:2040–3.
Andriole GL, Bostwick DG, Brawley OW, Gomella LG, Marberger M, Montorsi F, et al. Effect of dutasteride on the risk of prostate cancer. N Engl J Med. 2010;362:1192–202.
Simon RM, Howard LE, Moreira DM, Roehrborn C, Vidal AC, Castro-Santamaria R, et al. Does prostate size predict the development of incident lower urinary tract symptoms in men with mild to no current symptoms? Results from the REDUCE trial. Eur Urol. 2016;69:885–91.
Parsons JK. Benign prostatic hyperplasia and male lower urinary tract symptoms: epidemiology and risk factors. Curr Bladder Dysfunct Rep. 2010;5:212–8.
Trifiro MD, Parsons JK, Palazzi-Churas K, Bergstrom J, Lakin C, Barrett-Connor E. Serum sex hormones and the 20-year risk of lower urinary tract symptoms in community-dwelling older men. BJU Int. 2010;105:1554–9.
Partin AW, Yoo J, Carter HB, Pearson JD, Chan DW, Epstein JI, et al. The use of prostate specific antigen, clinical stage and Gleason score to predict pathological stage in men with localized prostate cancer. J Urol. 1993;150:110–4.
Nadler RB,Humphrey PA,Smith DS,Catalona WJ,Ratliff TL, Effect of inflammation and benign prostatic hyperplasia on elevated serum prostate specific antigen levels. J Urol. 1995;154:407–13.
Nickel JC, Roehrborn CG, O’Leary MP, Bostwick DG, Somerville MC, Rittmaster RS. The relationship between prostate inflammation and lower urinary tract symptoms: examination of baseline data from the REDUCE trial. Eur Urol. 2008;54:1379–84.
Kramer G, Mitteregger D, Marberger M. Is benign prostatic hyperplasia (BPH) an immune inflammatory disease? Eur Urol. 2007;51:1202–16.
Roehrborn CG. Definition of at-risk patients: baseline variables. BJU Int. 2006;97:7–11.
Lepor H, Wang B, Shapiro E. Relationship between prostatic epithelial volume and serum prostate-specific antigen levels. Urology. 1994;44:199–205.
Acknowledgements
The REDUCE study was funded by GlaskoSmithKline.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Patel, D.N., Feng, T., Simon, R.M. et al. PSA predicts development of incident lower urinary tract symptoms: results from the REDUCE study. Prostate Cancer Prostatic Dis 21, 238–244 (2018). https://doi.org/10.1038/s41391-018-0044-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41391-018-0044-y
This article is cited by
-
Navigating the Diagnostic Maze: Unraveling the Non-invasive Evaluation of Bladder Outlet Obstruction in Men—a Comprehensive Systematic Review
Current Bladder Dysfunction Reports (2023)
-
Identifying possible biomarkers of lower urinary tract symptoms using metabolomics and partial least square regression
Metabolomics (2023)
-
Semen as a rich source of diagnostic biomarkers for prostate cancer: latest evidence and implications
Molecular and Cellular Biochemistry (2022)
-
The significance of a high preoperative PSA level for the detection of incidental prostate cancer in LUTS patients with large prostates
World Journal of Urology (2021)