We assessed the relationship of American Urological Association (AUA) urinary symptom score and tumor stage in men treated for localized prostate cancer.
Methods: Participants in our study were found through urology and radiation oncology clinics, and all eligible patients were asked to take part. All patients had been initially diagnosed on the basis of rising PSA or abnormal physical examination. Histological confirmation of diagnosis was obtained for all subjects. Tumor stage was determined by digital rectal examination. 265 men with prostate cancer were studied.
Results: There was a significant difference in AUA symptom score in the three disease stages (p = 0.035, one way anova). Tukey's multiple range B test showed a significant difference between the AUA symptom scores of patients with t3 disease, when compared to patients with t1 and t2 disease (p = 0.05). The range test showed no significant difference between the AUA symptom scores of patients with t1 and t2 disease (p = 0.897). There was a significant difference in mean age of men with t1, t2, and t3 disease (p < 0.001). Men with t2 disease had a mean age of 69 years, as opposed to men with t1 and t3 disease (mean ages 66 and 64, respectively). Tukey's multiple range B test showed a significant difference (p = 0.05) between the ages of the men with t2 disease and the men with t1 or t3 disease. But there was no significant difference between the ages of the men with t1 and t3 disease. There was no relationship between age and AUA symptom score (r = 0.008, P = 0.89). The AUA symptom score index classifies the symptoms of men with a score of 0 to 7 as mild, 8 to 19 moderate, and 20 and above as severe. According to this classification, 55.6% of the prostate cancer patients we studied had mild symptoms, 37.1% had intermediate symptoms, and 7.3% had severe symptoms.
Conclusions: The majority (approximately 80%) of prostate cancers are found in the peripheral zone. But prostate cancers associated with urinary symptoms might arise in the periurethral transition zone, where almost all symptomatic benign prostatic hypertrophy originates. We hypothesize that symptomatic and non-symptomatic prostate cancer may be two distinct disease entities, each with its own characteristic genetic complement. In addition, urologists are actively seeking additional indicators of prostate cancer aggressiveness. Many prostate cancers are quite indolent and may never cause a problem, but it is impossible to identify such tumors with certainty. Further studies of AUA symptom score and outcome would be worthwhile. If AUA symptom score is a predictor of outcome that is independent of t stage, AUA score might be clinically valuable in disease management.