LUTS reduction lowers risk of death in older men

A decrease in lower urinary tract symptoms (LUTS) results in a reduced risk of death among men with benign prostatic hyperplasia (BPH), suggests a study.

“An improvement in the American Urological Association Symptom Score (AUASS) of older men with BPH is associated with a decreased risk of mortality over 6 years,” the researchers said. “Improvements in both storage and voiding symptoms are significantly associated with a lower risk of death.”

A secondary analysis was performed on the Medical Treatment of Prostate Symptoms (MTOPS), a randomized trial of placebo, doxazosin, finasteride, or doxazosin and finasteride. Participants included men in the US aged >50 years with moderate to severe LUTS between 1993 and 1998.

The researchers explored the association between AUASS (modeled as a time-varying exposure) and death using various Cox regression models.

In total, 3,046 men (median age 62 years) were randomly assigned and had a baseline AUASS. The hazard ratio (HR) for death was 0.96 (95 percent confidence interval [CI], 0.94‒0.99; p=0.01) for every 1-point improvement in the AUASS. [J Urol 2023;210:670-677]

Sensitivity analyses revealed a similar decrease in mortality risk among men who had active treatment, but not among those who received placebo. These results persisted when men were censored at the time of transurethral prostate resection, with adjustments for potential confounders, or with a shorter observation period after the last visit.

Notably, there was a similar decrease in mortality for each 1-point improvement in the storage (HR, 0.94, 95 percent CI, 0.88‒0.99; p=0.04) and voiding (HR, 0.95, 95 percent CI, 0.91‒0.99; p=0.03) subscales individually.

“Our results are unique as this is the first study, to our knowledge, to look at whether an improvement in male LUTS is associated with a lower risk of death, rather than showing an association between the degree of LUTS and mortality,” the researchers said.

These findings supported those of other similar studies. In particular, a large longitudinal Finnish study showed a higher risk of death (10 percent to 20 percent) in men with an increased magnitude of storage or voiding LUTS. [J Urol 2022;207:1285-1294]

Nocturia, along with urgency incontinence and frequency, was significantly associated with mortality risk. In a recent meta-analysis of 11 studies, the investigators found that two or more episodes of nocturia resulted in a 27-percent higher risk of death. Another study showed a 72-percent increased risk associated with three or more voids per night. [Prostate Cancer Prostatic Dis 2019;22:77-83]

“Currently, urinary symptoms are generally viewed as a benign condition and patients are treated if they have significant bother,” according to the researchers. “However, symptom bother is not perfectly correlated with the degree of symptoms; it is therefore possible that if there is a causal association between LUTS and mortality, earlier intervention based on symptom level alone would be appropriate.

“Further study is necessary to see if early LUTS treatment independently decreases the risk of mortality,” they said.