Effective treatment for lower urinary tract symptoms (LUTS) in men aged 50 or older is related to a lower risk of death over the following few years reports a study within the October issue of The Journal of Urology^®, an Official Journal of the American Urological Association (AUA). The journal is published within the Lippincott portfolio by Wolters Kluwer.

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 might have to view urinary symptoms otherwise, possibly with an emphasis on earlier treatment.”

Blayne Welk, MD, MSc, lead creator, Western University and Lawson Health Research Institute, London, Ont., Canada

Dr. Welk’s coauthor was Andrew McClure, MSc.

One-point reduction in urinary symptoms linked to 4% reduction in mortality

The researchers analyzed data on 3,046 men aged 50 years or with moderate to severe LUTS from a previous clinical trial (the Medical Treatment of Prostate Symptoms trial). Participants were randomly assigned to lively treatment with medications for LUTS – the alpha-1 blocker doxazosin, the 5-alpha reductase inhibitor finasteride, or a mixture of the 2 – or inactive placebo treatment.

Follow-up data were used to evaluate the connection between reduction in urinary symptoms and the chance of death after a mean of six years. Severity was assessed using a regular rating (the AUA Symptom Rating), which rates the impact of LUTS symptoms on a scale from 0 to 35. The patients’ median age was 62 years; 117 men died in the course of the two-year follow-up period.

“Improvement in male LUTS was related to a reduced risk of death,” the researchers write. For every one-point reduction in symptom rating, the relative likelihood (hazard ratio) for death decreased by 4%. Greater symptom reductions were linked to greater reductions risk of death: hazard ratio decreased by 12% with a three-point reduction in symptom rating and by 35% with a 10-point reduction in LUTS.

Men assigned to all three lively treatment groups had significant reductions in mortality risk, however the placebo group didn’t. The findings were consistent on further analyses including adjustment for potential confounding aspects or for surgical operation (transurethral prostate resection). Reductions in specific forms of symptoms (storage or voiding symptoms) were related to similar reductions in mortality.

Could earlier treatment for LUTS lower risk of death?

Lower urinary tract symptoms akin to weak stream and frequent nighttime urination (nocturia) are quite common in older men. Previous studies have linked moderate to severe LUTS to an increased risk of death. The brand new study is the primary to concentrate on whether improvement in male LUTS may reduce this excess risk of death.

The reduction in mortality in men receiving effective medications can have implications for the approach to treatment for LUTS in older men. Such urinary symptoms are generally viewed as a “benign condition,” treated only in the event that they develop into a bothersome problem for the patient.

The researchers emphasize that their study cannot determine whether there’s a causal relationship between improvement in LUTS symptoms and subsequent mortality risk. In that case, then earlier treatment based on symptom scores could be an appropriate strategy – analogous to the long-term reductions in mortality resulting from early treatment for mild increases in blood pressure.

The authors also note that the study didn’t evaluate the effect of other treatment options, including newer forms of selective alpha blockers. Dr. Welk and Mr. McClure conclude: “Further study is essential to see if early LUTS treatment independently decreases the chance of mortality.”