Reduction in men’s lower urinary tract symptoms linked to lower risk of death
Introduction
Benign prostatic hyperplasia (BPH) is a pathologic diagnosis often used to refer to a collection of symptoms (often called lower urinary tract symptoms (LUTS)) in older men. LUTS typically include storage symptoms, such as urinary frequency and nocturia, and vomiting symptoms, such as weak flow. While prostate enlargement due to BPH contributes significantly to LUTS, age-related changes in the bladder, metabolic syndrome, and vascular disease also play a role.
Globally, approximately 1 in 4 men will have BPH-related lower urinary tract symptoms (LUTS) in their lifetime, and the prevalence increases with age.
There is a considerable risk of LUTS worsening over time, and men usually seek treatment only when their symptoms cause significant discomfort. Current treatment guidelines suggest starting treatment based on the degree of bothersomeness of the symptoms.
Studies have shown that the risk of mortality is significantly increased with worse LUTS; While most research has focused on nocturia, male LUTS in general may also be associated with an increased risk of death. However, this observed association may be due to the confounding effects of frailty or cardiovascular disease (which is associated with both mortality and LUTS). Additional studies examining the association between LUTS and mortality are needed. Our objective was to determine whether improvement in male LUTS in the context of medical treatment is associated with a reduced risk of mortality.
graphic summary
Objective:
Lower urinary tract symptoms in men are associated with an increased risk of death; However, it is not clear whether treatment will reduce this risk. Our objective was to determine whether reduction in lower urinary tract symptoms is associated with a reduced risk of mortality.
Materials and methods:
We conducted a secondary analysis of the MTOPS (Medical Treatment of Prostate Symptoms) randomized trial of placebo, doxazosin, finasteride, or doxazosin and finasteride. Men between 1993 and 1998 in the United States who were over the age of 50 and had moderate to severe lower urinary tract symptoms were included.
We used multiple Cox regression models to evaluate the relationships between aua symptom score (modeled as time-varying performance) and death.
Result:
total of 3046 men (median age 62, quartiles 57–68) were randomized and had a baseline AUA symptom score. For each 1-point improvement in AUA symptom score, the hazard ratio of death was 0.96 (0.94–0.99, P=0.01).
Our sensitivity analyzes found a similar significant reduction in the hazard ratio of death in men who received active treatment, but not in men who were randomly assigned to the placebo group; Our results did not change when men were censored at the time of transurethral resection of the prostate, with adjustment for potential confounders, or with a shorter observation period after the last study visit.
A comparable significant reduction in mortality was seen with a 1-point improvement in the storage (HR 0.94, 95% CI 0.88-0.99, P = 0.04) and voiding subscales (HR 0.94, 95% CI 0.88-0.99, P = 0.04). 95 , 95% CI: 0.91–0.99, P = 0.03) individually.
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conclusion:
Improvement in AUASS of older men with BPH is associated with reduced risk of mortality at 6 years. Improvement in storage and urination symptoms was significantly associated with a reduced risk of death.
Further studies are needed to see whether early treatment of LUTS independently reduces the risk of mortality.
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Discussion
We used data from existing and well-known randomized trials of MTOPS (Medical Treatment of Prostate Symptoms) To evaluate whether improvement in urinary symptoms is independently associated with reduced risk of mortality in men with BPH. We found that for each 1-point improvement on the AUASS there was a statistically significant 4% reduction in mortality risk. Although this is a small decrease, it is clinically significant given the importance of the outcome.
A similar and statistically significant reduction in mortality risk was seen when a 1-point improvement was seen in storage symptoms alone (6%) or urination symptoms alone (5%).
The point estimate for the single-night question was in a similar direction (10% reduction in mortality for each 1-point improvement); However, this was not statistically significant, possibly as a result of reduced discriminatory power, as there was only one question measuring nocturia on the AUASS.