To determine whether decreased peak urine flow is associated with future incident lower urinary tract symptoms (LUTS) in men with mild to no LUTS.
Our population consisted of (3,140) men from the REDUCE trial with mild to no LUTS defined as an International Prostate Symptom Score (IPSS)<8. REDUCE was a randomized trial of dutasteride vs. placebo for prostate cancer prevention in men with an elevated PSA and a negative biopsy. IPSS measures were obtained every 6 months throughout the 4-year study. The association between peak urine flow rate and progression to incident LUTS, defined as the first of medical treatment, surgery, or sustained, clinically significant LUTS symptoms was tested using multivariable Cox models adjusting for various baseline characteristics and treatment arm.
On multivariable analysis, as a continuous variable decreased peak urine flow rate was significantly associated with increased risk of incident LUTS (p=0.002); results were similar in the dutasteride and placebo arms. When peak flow was categorized as ≥15mL/s, 10-14.9mL/s, and <10mL/s, flow rates of 10-14.9mL/s and <10mL/s were associated with a significantly increased risk of developing incident LUTS in univariable analysis (HR=1.39, p=0.011 and HR=1.67, p<0.001, respectively). Results were similar in multivariable analysis, though the 10-14.9 mL/s group was no longer statistically significant (HR 1.26, p=0.071).
In men with mild to no LUTS, decreased peak urine flow rate is independently associated with incident LUTS. If confirmed, these men should be followed closer for incident LUTS.
The Journal of urology. 2017 Apr 17 [Epub ahead of print]
Ross M Simon, Lauren E Howard, Daniel M Moreira, Claus Roehrborn, Adriana Vidal, Ramiro Castro-Santamaria, Stephen J Freedland
Department of Urology, University of South Florida College of Medicine, Tampa, FL., Duke Prostate Center, Division of Urology, Department of Surgery and Pathology, Duke University School of Medicine, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC; Department of Urology, Durham Veterans Affairs Medical Center, Durham, NC., Department of Urology, Mayo Clinic, Rochester, MN., Department of Urology, UT Southwestern Medical Center, Dallas, TX., Metabolic Pathways and Cardiovascular R&D Unit, GlaxoSmithKline Inc., King of Prussia, Pennsylvania., Department of Urology, Durham Veterans Affairs Medical Center, Durham, NC; Department of Surgery, Division of Urology, and Center for Integrated Research on Cancer and Lifestyle, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles California. Electronic address: .