Effective medical management of LUTS may lower mortality risk

Men aged 50 or older who received medication that improved their lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) had a reduced risk of mortality over 6 years compared with men who did not receive treatment, according to findings published in the Journal of Urology.¹

For every 1-point improvement in American Urological Association (AUA) Symptom Score for BPH, there was a 4% decreased risk of mortality.

"We found a small but significant decrease in mortality risk for older men who received medications for treatment of LUTS. The findings suggest that we may need to view urinary symptoms differently, possibly with an emphasis on earlier treatment,” said lead author Blayne Welk, MD, FRCSC, MSc, in a news release on the findings.² Welk is an associate professor of surgery at Western University and Lawson Health Research Institute in London, Ontario, Canada.

For the study, the investigators conducted a secondary analysis of data from the Medical Treatment of Prostate Symptoms (MTOPS) study. A total of 3046 men aged 50 and older with moderate to severe BPH-related LUTS were included in the analysis. Patients in the MTOPS study had been randomly assigned to placebo (n = 737) or active treatment (n = 2309) with doxazosin, finasteride, or combination doxazosin/finasteride. The median age of participants was 62, and median follow-up time was 6.6 years.

Data from the analysis showed a reduction in the hazard ratio for mortality among patients who were on active treatment (HR, 0.95; 95% CI, 0.92-0.98), but not among patients who had been assigned to placebo (HR, 1.02; 95% CI, 0.96-1.08). These findings remained consistent even when controlling for the confounders of diabetes, hypertension, and a history of kidney disease (P = .01), as well as when men were censored at the time of transurethral prostate resection (P < .01) or had a shorter observation period after the last study visit (P = .02).

Further, for every 1-point improvement in American Urological Association (AUA) Symptom Score for BPH, there was a 4% decreased risk of mortality (HR, 0.96; 95% CI, 0.94-0.99; P = .01). Likewise, a 3-point improvement in AUA Symptom Score was associated with a 12% reduction in the risk of mortality (HR, 0.88; 95% CI, 0.81-0.95), and a 10-point improvement was associated with a 35% reduction in the risk of mortality (HR 0.65; 95% CI, 0.51-0.83).

When looking at specific symptoms measured with the AUA Symptom Score, the investigators observed that a 1-point improvement in storage was associated with a 6% reduction in the risk of mortality (HR, 0.94; 95% CI, 0.88-0.99; P = .04), and a 1-point improvement in voiding was associated with a 5% reduction in the risk of mortality (HR, 0.95; 95% CI, 0.91-0.99; P = .03).

The authors noted that these findings may indicate that early intervention is beneficial, though “Further study is necessary to see if early LUTS treatment independently decreases the risk of mortality.”

References

1. Welk B, McClure JA. The reduction of male lower urinary tract symptoms is associated with a decreased risk of death. J Urol. Published online September 8, 2023. Accessed September 15, 2023. doi:10.1097/JU.0000000000003602

2. For older men, treating urinary symptoms may lead to lower mortality risk. News release. Wolters Kluwer Health: Lippincott. September 11, 2023. Accessed September 15, 2023. https://www.newswise.com/articles/for-older-men-treating-urinary-symptoms-may-lead-to-lower-mortality-risk