Modern-day prostate cancer is not meaningfully associated with lower urinary tract symptoms: Analysis of a propensity scorematched cohort

Introduction: 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. Methods: 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 highgrade, high-volume, and high-stage cancers only, and excluding users of benign prostatic hyperplasia medications. Results: 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. Conclusions: 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.