Abstract
The International Prostate Symptom Score (IPSS) is often used as an interview sheet for assessing lower urinary tract symptoms (LUTS) at the time of prostate-specific antigen (PSA) testing during population-based screening for prostate cancer. However, the relationship between prostate cancer detection and LUTS status remains controversial. To elucidate this relationship, the cumulative probability of prostate cancer detection using IPSS in biopsy samples from patients categorized by serum PSA levels was investigated. The clinical characteristics of prostate cancer detected using IPSS during screening were also investigated. A total of 1,739 men aged 54-75 years with elevated serum PSA levels who completed the IPSS questionnaire during the initial population screening in Kanazawa City, Japan and underwent systematic transrectal ultrasonography-guided prostate biopsy between 2000 and 2013 were enrolled in the present study. Of the 1,739 men, 544 (31.3%) were diagnosed with prostate cancer during the observation period. The probability of cancer detection at 3 years in the entire study population was 27.4% and 32.7% for men with IPSS ≤ 7 and those with IPSS ≥ 8, respectively; there was no statistically significant difference between groups. In men with serum PSA levels of 6.1 to 12.0 ng/ mL at initial screening, the probability of cancer detection was significantly higher in men with IPSS ≤ 7 than in those with IPSS ≥ 8. There were no significant differences in clinical characteristics between groups of patients stratified by IPSS. These findings indicate that the use of IPSS for LUTS status evaluation may be useful for prostate cancer detection in the limited range of serum PSA levels.
Highlights
Prostate-specific antigen (PSA)-based screening is widely used for the early detection of prostate cancer
prostate-specific antigen (PSA)-based screening systems implemented by municipal governments are reasonable measures to increase the exposure to PSA testing; several studies have already suggested that these systems may be effective for the early detection of prostate cancer (Kubota et al, 2002; Okihara et al, 2008; Kitagawa et al, 2011)
It was found that asymptomatic patients diagnosed with prostate cancer through PSA testing had a better prognosis compared with symptomatic patients (Kubota et al, 2003; Kitagawa et al, 2013)
Summary
Prostate-specific antigen (PSA)-based screening is widely used for the early detection of prostate cancer. In Asian countries, the screening rate for prostate cancer is still very low compared with that in the USA and West Europe. Since the 1990s, each municipal government in Japan has provided prostate cancer screening systems, and a decreased mortality rate for prostate cancer is expected in some regions with a marked increase in the PSA testing rate (Ito et al, 2009). PSA-based screening systems implemented by municipal governments are reasonable measures to increase the exposure to PSA testing; several studies have already suggested that these systems may be effective for the early detection of prostate cancer (Kubota et al, 2002; Okihara et al, 2008; Kitagawa et al, 2011)
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