1926 LOWER URINARY TRACT SYMPTOMS (LUTS) ARE RISK FACTORS FOR ADVANCED PROSTATE CANCER IN JAPANESE ELDERLY MEN

cancer (PC), metastasis, and dying from PC in men aged 55-69 yrs at baseline, and the correlation with initial PSA. METHODS: Men selected from the population registry of Rotterdam were invited for the pilot study. Participants with a baseline PSA 10 ng/ml were excluded and directly referred to the general practitioner. The remaining men in the intervention arm were screened every 4 yrs with an age cut-off of 74 yrs; lateralized sextant prostate biopsy was recommended for a PSA 4 ng/ml and 3 ng/ml starting from 1997. Men in the control arm were not screened. The number of cancers, metastases and PC deaths were assessed, and related to the initial PSA levels. Hazard ratios were determined using Cox models. RESULTS: In total, 905 men aged 55-69 yrs at baseline were enrolled (Table). The median PSA level at baseline was 1.0 ng/ml. An initial PSA at or greater than the median was associated with a 5.0-fold risk of PC when compared to PSA levels less than the median (p 0.001) in the intervention arm, whereas the risk was 6.3-fold in the control arm (p 0.001). In the intervention arm, four men developed metastasized disease and two eventually died from the disease; all had an initial PSA above the median. In the control arm an initial PSA greater than the median was associated with a 2.9-fold risk of metastasized disease (p 0.12) and a 1.5-fold risk of dying from PC (p 0.58). CONCLUSIONS: This pilot study with initial PSA levels of all participants shows that baseline PSA predicts the development of PC during a median follow-up of 16 yrs, irrespective of the allocated study arm. Despite the small number of events, it should be noted that the men in the intervention arm with metastasis and who died from PC all had an initial PSA above the median, whereas in the control arm no significant correlation was observed in baseline PSA and the risk of developing metastasis or dying from PC. This suggests that a single PSA at baseline might not be sufficient for risk classification, and that repeat PSA screening may be needed to prevent metastasis and death from PC.