Practice Uncertainties

Do men with lower urinary tract symptoms have an increased risk of advanced prostate cancer?

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1202 (Published 03 May 2018) Cite this as: BMJ 2018;361:k1202
  1. Jenny Østerø í Jákupsstovu, research assistant1,
  2. John Brodersen, professor1 2
  1. 1Centre of Research and Education in General Practice, Department of Public Health, University of Copenhagen, Denmark
  2. 2Primary Health Care Research Unit, Region Zealand, Denmark
  1. Correspondence to tmw139{at}alumni.ku.dk

What you need to know

  • It is uncertain if lower urinary tract symptoms are associated with an increased risk of advanced prostate cancer

  • Do not routinely offer prostate specific antigen (PSA) testing in men with only lower urinary tract symptoms and no risk factors for prostate cancer

  • Explain the limitations and harms of a PSA test to the patient in terms of downstream procedures, and the possibility of being diagnosed with prostate cancer that might not cause him symptoms or shorten his life

A 72 year old man complains of increased frequency of urination, particularly at night. He also describes a sense of incomplete voiding and a poor stream. He is concerned about whether he might have prostate cancer, and wants to be reassured that this is not the case.

More than half of all men over 50 report problems with urinating.1

Grouped as lower urinary tract symptoms (LUTS), these signify problems with the storage and/or voiding of urine, and are often caused by benign prostatic enlargement.1 LUTS are habitually considered a possible symptom of prostate cancer,2 and qualitative studies show that men with LUTS are worried about having prostate cancer and consult a doctor to seek reassurance.345 Prostate cancer is one of the most diagnosed cancers in men worldwide. During the previous two to three decades, prostate cancer incidence has greatly increased in high income countries; however, at the same time the mortality of prostate cancer has stayed stable or decreased slightly. Advanced prostate cancer is potentially fatal. In contrast, indolent prostate cancer is per definition harmless and does not cause morbidity or mortality. Moreover, indolent prostate cancer is the most frequent form of prostate cancer, eg, autopsy studies estimate the mean prevalence of indolent prostate cancer to be 59% in men >79 years.6 Collated with the …

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