PD39-11 PEAK URINE FLOW PREDICTS DEVELOPMENT OF SYMPTOMATIC BPH IN MEN WITH MILD TO NO URINARY SYMPTOMS: RESULTS FROM REDUCE

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Epidemiology and Natural History1 Apr 2015PD39-11 PEAK URINE FLOW PREDICTS DEVELOPMENT OF SYMPTOMATIC BPH IN MEN WITH MILD TO NO URINARY SYMPTOMS: RESULTS FROM REDUCE Ross Simon, Lauren Howard, Daniel Moreira, Stephen Freedland, Claus Roehrborn, and Adriana Vidal Ross SimonRoss Simon More articles by this author , Lauren HowardLauren Howard More articles by this author , Daniel MoreiraDaniel Moreira More articles by this author , Stephen FreedlandStephen Freedland More articles by this author , Claus RoehrbornClaus Roehrborn More articles by this author , and Adriana VidalAdriana Vidal More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2406AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Decreased peak urinary flow (Qmax) is a well-established consequence of symptomatic benign prostatic hyperplasia (BPH). The clinical relevance of Qmax in men with mild to no urinary symptoms is unclear. We assessed the link between Qmax and incident symptomatic BPH in men with mild to no BPH symptoms. METHODS We performed an analysis of REDUCE to test the link between Qmax and incident symptomatic BPH. REDUCE was a multicenter, randomized, double-blind, placebo-controlled trial of prostate cancer risk reduction with daily dutasteride 0.5 mg or placebo. Eligible men were aged 50-75 yrs, with a PSA 2.5-10 ng/mL and prostate volume ≤80 mL. Men were followed for 4 years with International Prostate Symptom Scores (IPSS) at baseline and every 6 months. We defined incident symptomatic BPH as two consecutive IPSS ≥12, one IPSS ≥14, or receiving medical or surgical BPH treatment. We included 3,109 men with IPSS <8 (mild to no symptoms) who were not taking 5 alpha-reductase inhibitors or alpha blockers at baseline. We tested the association of Qmax with incident symptomatic BPH using multivariable Cox models adjusting for age (continuous), white race (vs. non-white), prostate volume (continuous), baseline PSA (continuous, logarithmically transformed), and baseline IPSS (continuous). As the association between Qmax and incident symptomatic BPH was similar in men on dutasteride or placebo (p-interaction=0.636), analysis included all men. RESULTS During the 4-year study, 366 (12%) had incident symptomatic BPH progression. Median Qmax was 14.1 mL/s. As a continuous variable, the negative log of Qmax predicted incident symptomatic BPH (HR 1.40, p=0.005). In other words, men with lower Qmax were at higher risk of incident symptomatic BPH. When categorized, men with Qmax <15mL/s had a 28% increased risk of incident symptomatic BPH (HR 1.28, p=0.024). CONCLUSIONS In REDUCE, a Qmax <15mL/s in men with an IPSS<8 predicted onset of symptomatic BPH. If confirmed in other studies, these findings suggest men with no to mild urinary symptoms but low Qmax, are at increased risk for incident symptomatic BPH over the next 4 years and these men may merit closer observation. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e834 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ross Simon More articles by this author Lauren Howard More articles by this author Daniel Moreira More articles by this author Stephen Freedland More articles by this author Claus Roehrborn More articles by this author Adriana Vidal More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...