How do I save PDF to an output stream?

Is there a way to save a PDF to an output stream. Like say the
Reponse.OutputStream or a memory stream. I don't want to have to save
the pdf to a file first if I dont have to.

Simply use a version of 'PDFDoc.Save()' that accepts a byte array. For
an example of how to save a PDF to a memory buffer you may want to
take a look at PDFDocMemory sample project: