American Urological Association Symptom Index Research Articles

The role of prophylactic Tamsulosin ± dexamethasone in patients undergoing prostate 125I seed implants for prostate carcinoma. A randomized double-blind study

Introduction: In this study, we aimed to evaluate the effectiveness of prophylactic dexamethasone added to tamsulosin (Flomax®) in reducing urinary symptoms after I 125 prostate brachytherapy (PI) for prostate adenocarcinoma. Materials and Methods: A single institution, randomized, double blind, placebo controlled trial of patients undergoing PI for prostate adenocarcinoma comparing the use of prophylactic dexamethasone plus tamsulosin before PI versus placebo plus tamsulosin was conducted. Patients undergoing permanent PI, who were not taking tamsulosin or other alpha-blockers prior to PI were eligible for the trial. All patients were given tamsulosin (0.8 mg, orally once a day) and were randomized to receive either placebo or dexamethasone (4 mg per day for the first 10 days after PI and then 2 mg per day for 4 additional days). Tamsulosin use was started four days prior to PI and continued for 60 days. Urinary symptoms were assessed with the American Urologic Association (AUA) symptom index score. The questionnaire was administered prior to PI and then on a weekly basis for the first eight weeks after PI and again at weeks 10 and 12 after PI. The primary endpoint of the trial was change in the AUA score from baseline. Patients were taken off of the study if they developed urinary retention, had intolerable urinary symptoms, or wished to discontinue with the trial. Results: One-hundred patients were enrolled in the study. Ninety-four patients started the study and 72 completed all 12 weeks. Patients were evenly matched according to pre-treatment and post-treatment characteristics except with regard to pre-treatment AUA score: the dexamethasone group had a median score of 3 while the placebo group had a median score of 5 (p=0.0023). When comparisons were made between the groups relative to percent change in overall AUA score from baseline, there was a significant difference in favor of the placebo group (p=0.0030). Conclusion: The combination of prophylactic dexamethasone and tamsulosin yields worse post-operative

Voiding dysfunction in young, nulliparous women: symptoms and urodynamic findings.

The objective was to determine urodynamic findings in young, premenopausal, nulliparous women with bothersome lower urinary tract symptoms and assess whether or not symptoms are predictive of specific urodynamic abnormalities. The records of 57 women were reviewed. Those with neurological disease or a primary complaint of stress incontinence were excluded. All completed the American Urological Association Symptom Index (AUASI) and underwent videourodynamics. Symptoms were compared in patients with and without bladder dysfunction and/or voiding phase dysfunction. Bladder dysfunction was diagnosed in 86% of patients with urge incontinence vs. 17% of those without (p<0.0001). Patients with voiding phase dysfunction had higher total and voiding AUASI scores. Occult neurological disease was later diagnosed in 4 women (24%) with urge incontinence and bladder dysfunction. Urge incontinence and voiding symptoms are frequently associated with urodynamically demonstrable abnormalities. Urge incontinence and bladder dysfunction may be a sign of occult neurological disease in this population. The presenting symptoms are useful in determining the utility of urodynamics in this population.

Relationships Between American Urological Association Symptom Index, Prostate Volume, and Disease-Specific Quality of Life Question in Patients with Benign Prostatic Hyperplasia

The American Urological Association (AUA) symptom index is both valid and reliable in identifying the need to treat patients with benign prostatic hyperplasia (BPH) and in monitoring their response to therapy. We evaluated the relationships between AUA symptom index, disease-specific quality of life question, and prostate volume in patients with BPH. A total of 100 patients who came to Kaohsiung Medical University Hospital, Taiwan, for help due to lower urinary tract symptoms (LUTS) and who were diagnosed with BPH between October 2002 and June 2003 were included in the study. All patients were evaluated using transrectal ultrasonography, AUA symptom index, and disease-specific quality of life question. The disease-specific quality of life question showed good correlation with AUA symptom score (r = 0.815, p < 0.01), but weak correlation with prostate volume (r = 0.225, p < 0.05) and age (r = 0.274, p < 0.05). Prostate volume had weak correlation with AUA symptom score (r = 0.251, p < 0.05) and age (r = 0.472, p < 0.01), but good correlation with prostate specific antigen (r = 0.638, p < 0.01). In addition to AUA symptom index, we suggest using the disease-specific quality of life question to evaluate the influence on quality of life and response to treatment in clinical practice. Moreover, we should assess the impact of BPH symptoms rather than the increase in prostate volume during the management of BPH.

Lower Urinary Tract Symptoms and Sexual Dysfunction in Community-Dwelling Men

Objectives To evaluate the cross-sectional association between lower urinary tract symptoms (LUTS) severity and sexual function in a population-based sample of men and the extent to which this association might be explained by age. Subjects and Methods Subjects in The Olmsted County Study of Urinary Symptoms and Health Status Among Men (55% participation rate) included 2115 white men aged 40 to 79 years; subjects were recruited on January 1, 1990, from a random sample identified through the Rochester Epidemiology Project. At baseline in 1990 and biennially thereafter, these men completed a self-administered questionnaire that assessed LUTS severity with questions similar to those of the American Urological Association Symptom Index. At the 6-year follow-up, 11 previously validated questions about male sexual function from the Brief Sexual Function Inventory were added. Results Overall, each of the sexual function domains (sexual drive, erectile function, ejaculatory function, problem assessment, and overall sexual satisfaction) was inversely associated with the severity of LUTS, with Spearman correlation coefficients ranging from –0.21 to –0.31 (all P<.001). In age-adjusted analyses, the ejaculatory function and problem assessment domains were most strongly associated with overall LUTS severity, whereas the association with sexual drive was substantially diminished. Little difference was noted in the magnitude of association between sexual function and either obstructive or irritative symptoms. Conclusions The cross-sectional data suggest that sexual function is inversely associated with LUTS severity and that this association is only partially attributable to the confounding effects of age. To evaluate the cross-sectional association between lower urinary tract symptoms (LUTS) severity and sexual function in a population-based sample of men and the extent to which this association might be explained by age. Subjects in The Olmsted County Study of Urinary Symptoms and Health Status Among Men (55% participation rate) included 2115 white men aged 40 to 79 years; subjects were recruited on January 1, 1990, from a random sample identified through the Rochester Epidemiology Project. At baseline in 1990 and biennially thereafter, these men completed a self-administered questionnaire that assessed LUTS severity with questions similar to those of the American Urological Association Symptom Index. At the 6-year follow-up, 11 previously validated questions about male sexual function from the Brief Sexual Function Inventory were added. Overall, each of the sexual function domains (sexual drive, erectile function, ejaculatory function, problem assessment, and overall sexual satisfaction) was inversely associated with the severity of LUTS, with Spearman correlation coefficients ranging from –0.21 to –0.31 (all P<.001). In age-adjusted analyses, the ejaculatory function and problem assessment domains were most strongly associated with overall LUTS severity, whereas the association with sexual drive was substantially diminished. Little difference was noted in the magnitude of association between sexual function and either obstructive or irritative symptoms. The cross-sectional data suggest that sexual function is inversely associated with LUTS severity and that this association is only partially attributable to the confounding effects of age.

Lower Urinary Tract Symptoms and Sexual Dysfunction in Community-Dwelling Men

To evaluate the cross-sectional association between lower urinary tract symptoms (LUTS) severity and sexual function in a population-based sample of men and the extent to which this association might be explained by age. Subjects in The Olmsted County Study of Urinary Symptoms and Health Status Among Men (55% participation rate) included 2115 white men aged 40 to 79 years; subjects were recruited on January 1, 1990, from a random sample identified through the Rochester Epidemiology Project. At baseline in 1990 and biennially thereafter, these men completed a self-administered questionnaire that assessed LUTS severity with questions similar to those of the American Urological Association Symptom Index. At the 6-year follow-up, 11 previously validated questions about male sexual function from the Brief Sexual Function Inventory were added. Overall, each of the sexual function domains (sexual drive, erectile function, ejaculatory function, problem assessment, and overall sexual satisfaction) was inversely associated with the severity of LUTS, with Spearman correlation coefficients ranging from -0.21 to -0.31 (all P<.001). In age-adjusted analyses, the ejaculatory function and problem assessment domains were most strongly associated with overall LUTS severity, whereas the association with sexual drive was substantially diminished. Little difference was noted in the magnitude of association between sexual function and either obstructive or irritative symptoms. The cross-sectional data suggest that sexual function is inversely associated with LUTS severity and that this association is only partially attributable to the confounding effects of age.

Efficacy and safety of dutasteride in the four-year treatment of men with benign prostatic hyperplasia

Objectives To assess the long-term safety and efficacy of dutasteride, a dual type 1 and type 2 5-α-reductase inhibitor, in the treatment of symptomatic benign prostatic hyperplasia and associated lower urinary tract symptoms. Methods Data from two Phase IIIa multicenter, randomized, placebo-controlled trials of 2-year duration plus a 2-year open-label extension were pooled and analyzed. The entry criteria included age 50 years old or older, clinical diagnosis of benign prostatic hyperplasia, prostate volume of 30 cm 3 or greater, American Urological Association symptom score of 12 or greater, peak urinary flow rate of 15 mL/s or less, and prostate-specific antigen level of 1.5 ng/mL or greater but less than 10 ng/mL. Results A total of 2802 men were randomized into the double-blind phase of the two studies with 1908 patients (68%) completing the study. Of these, 1570 subjects were enrolled in the open-label phase, and 569 subjects received dutasteride for 48 months. Changes at the 48-month visit for dutasteride/dutasteride-treated subjects included improvement in prostate volume (−26.2%), American Urological Association Symptom Index (−6.1 points), and peak urinary flow rate (+2.8 mL/s). Changes for the placebo/dutasteride group included prostate volume (−20.7%), American Urological Association Symptom Index (−5.3 points), and peak urinary flow rate (+1.8 mL/s). Acute urinary retention and surgery occurred in a small percentage of subjects (less than 2% and less than 1%) in the open-label extension phase. Dutasteride was well tolerated with no statistically significant increase in drug-related adverse events during the open-label extension and no adverse laboratory trends. Conclusions Dual inhibition of 5-α-reductase with dutasteride provided sustained efficacy in subjects with symptomatic benign prostatic hyperplasia treated for 48 months. Near-complete, long-term suppression of dihydrotestosterone (93% at 48 months) with dutasteride did not lead to an increase in adverse events compared with that reported in the 2-year period.

Serum sex hormones and measures of benign prostatic hyperplasia.

Despite biologic plausibility, the associations between sex hormones and measures of benign prostatic hyperplasia (BPH) have not been consistently reported. Subjects were randomly selected from the Olmsted County, MN population (n, 320; median age, 60.9 years) and followed biennially since 1990. In 2002, surrogate measures of BPH were assessed from an approximation of the American Urological Association Symptom Index (AUASI), Peak urinary flow rates (Q(max)), and a transrectal ultrasound assessment of prostate volume. Serum levels of prostate specific antigen (PSA), testosterone, bioavailable testosterone, and estradiol were also measured. Bioavailable testosterone levels declined with increasing cross-sectional age from 53.8, 50.2, to 41.2 ng/dl (P = 0.001) in men aged <60, 60-69, and >69 years, respectively, and the estradiol/bioavailable testosterone ratio increased from 0.042, 0.044, to 0.050 (P = 0.04). Among men with bioavailable testosterone above the median, estradiol levels had a dose response relationship with prostate size. Among men with bioavailable testosterone level </= the median, however, there was no association between estradiol level and prostate volume While cross-sectional, these findings suggest a more complex relationship between sex steroids and prostate volume in older men than simple independent effects.

The Impact of Open Radical Retropubic Prostatectomy on Continence and Lower Urinary Tract Symptoms: A Prospective Assessment Using Validated Self-Administered Outcome Instruments

We determined the impact of radical retropubic prostatectomy on continence and lower urinary tract symptoms (LUTS). Between October 2000 and August 2002, 500 men with clinically localized prostate cancer underwent radical retropubic prostatectomy by a single surgeon, and completed the UCLA Prostate Cancer Index and American Urological Association (AUA) symptom index at baseline, 3, 6, 12 and 24 months after radical prostatectomy. Univariate analysis was performed to identify factors predisposing the early return of continence. A total of 100%, 98.3%, 97.1%, 94.2% and 98.6% of patients filled out the UCLA Prostate Cancer Index and AUA symptom index at baseline, and 3, 6, 12 and 24 months, respectively. Based on protective pad requirement or frequency of incontinence 100%, 90.9%, 87.2%, 92.1% and 98.5% vs 98.8%, 80.6%, 91.2%, 95.2% and 98.5% of men were continent at baseline, 3, 6, 12 and 24 months after surgery, respectively. Age, severity of lower urinary tract symptoms, Gleason score, nerve sparing status, blood loss or presence of benign prostatic tissue in the apical soft tissue margin did not predict early return of continence. All of the individual urinary symptoms captured by the AUA symptom score showed significant improvement after radical retropubic prostatectomy. Radical prostatectomy was associated with a mean 5.4 unit decrease in AUA symptom score (40% decrease) in men with baseline moderate/severe LUTS (AUA symptom score 8 or greater). The majority of men regain continence after radical retropubic prostatectomy and maximal continence is achieved by 24 months. No factors were identified that predicted early return of continence in our cohort of men undergoing radical prostatectomy. Radical prostatectomy has a clinically significant impact on improving LUTS.

Androgen receptor gene polymorphisms and increased risk of urologic measures of benign prostatic hyperplasia.

The association between androgen receptor gene polymorphisms and benign prostatic hyperplasia was investigated among 510 men randomly selected from Olmsted County, Minnesota. From 1990 through 2000, lower urinary tract symptom severity was assessed by the American Urological Association Symptom Index (AUASI), and peak urinary flow rate, prostate volume, and serum prostate-specific antigen level were measured. Androgen receptor CAG and GGN genotyping was performed. A CAG repeat length of <21 was associated with an enlarged prostate (hazard ratio (HR) = 1.4, 95% confidence interval (CI): 1.0, 1.9) and a serum prostate-specific antigen level >1.4 ng/ml (HR = 1.5, 95% CI: 1.1, 2.0). A GGN repeat length of <16 was associated with an AUASI >7 (HR = 1.6, 95% CI: 1.1, 2.3) and a serum prostate-specific antigen level >1.4 ng/ml (HR = 1.5, 95% CI: 1.0, 2.3). Having <21 CAG repeats and <16 GGN repeats compared with having neither was associated with an enlarged prostate (HR = 2.5, 95% CI: 1.5, 4.2), a serum prostate-specific antigen level >1.4 ng/ml (HR = 2.8, 95% CI: 1.6, 4.7), a peak flow rate <12 ml/second (HR = 1.9, 95% CI: 1.1, 3.4), and an AUASI >7 (HR = 1.6, 95% CI: 1.0, 2.7). Androgen receptor gene polymorphisms may have a potential role in the pathogenesis of benign prostatic hyperplasia.

Degree of bother caused by nocturia in women.

The prevalence of nocturia in women has been studied, but its severity has not been categorized based on degree of bother. The number of nighttime voids that defines clinically significant nocturia has not been established. The objective of this study was to establish how bothersome nocturia is in women and to determine whether number of nighttime voids correlates with the degree of bother. We also sought to determine if this correlation was affected by age or continence status. The charts of 1,214 neurologically healthy women that presented to a female urology office were reviewed. All women completed the American Urological Association Symptom Index (AUASI) and the symptom problem index (SPI). Question no. 7 of the AUASI assesses the number of voids per night and question no. 3 of the SPI assesses the bother of nighttime voiding. The correlation of these two variables was evaluated using a proportional odds model. Mean age was 54.6 years (18-93). 87.3% complained of waking at least one time per night to void. Bother score increased as the number of nightly voids increased, irrespective of age or continence status. The proportional odds model showed that as the number of voids increases 1 value on AUASI, the odds of having an increase in bother increases 2.7 times (P<0.0001). As the number of nighttime voiding episodes increases, the bother increases, independent of age or continent status. Based on the degree of bother, we propose that clinically significant nocturia in women be classified as two or more episodes per night.

The role of prophylactic tamsulosin (Flomax®) on obstructive and irritative urinary symptoms in patients undergoing prostate 125i seed implants for prostate carcinoma: a single institution double-blind randomized study

Materials/Methods: A double-blind, placebo controlled, randomized trial for patients undergoing 125I prostate implant (PI) comparing prophylactic tamsulosin vs placebo was performed. Eligibility criteria included patients undergoing PI, who were not taking tamsulosin or other alpha-blockers prior to PI. Patients received either placebo or tamsulosin (0.8 mg to be taken PO once a day). All patients started the medication 4 days prior to prostate implant and continued for a duration of 60 days. Patients were taken off the study if they developed urinary retention, had intolerable urinary symptoms, or wished to discontinue the trial. The American Urologic Association (AUA) symptom index questionnaire was used at baseline and on a weekly basis for 8 weeks to assess the irritative and obstructive urinary symptoms after PI. Irritative urinary symptoms included nocturia, urgency, and daytime urinary frequency. Obstructive urinary symptoms included the force of urinary stream, hesitancy, feeling of bladder emptiness, and straining to start urination. Irritative and obstructive symptoms were evaluated for the entire study period utilizing repeated measures analysis of variance (ANOVA) and unpaired t-tests for week by week comparisons.

The role of prophylactic tamsulosin (Flomax) in patients undergoing prostate 125-I seed implants for prostate carcinoma: final report of double-blind placebo-controlled randomized study

Materials/Methods: A single institution, double blind, placebo controlled, randomized trial for patients undergoing 125I prostate implant (PI) comparing prophylactic Tamsulosin (Flomax) vs. placebo. Eligibility criteria include patients undergoing PI, who were not taking Tamsulosin (Flomax) or other alpha-blockers prior to PI. The patients received either placebo or Tamsulosin (Flomax)(0.8 mg) to be taken PO once a day). All patients started the medication 4 days prior to prostate implant for duration of 60 days after PI. The American Urologic Association (AUA) symptom index questionnaire was used at baseline and on a weekly basis for 8 weeks to assess the severity of urinary symptoms after PI. For quality assurance purpose, all AUA questionnaires were conducted by one physician (ME). Patients were taken off the study if they developed urinary retention, had intolerable urinary symptoms, or did not wish to continue with the trial. Repeated measures analysis of variance (ANOVA) was done to see if there was a difference in AUA scores between the two treatment arms over the duration of the study period. Unpaired t-tests were done to compare AUA score between the two arms on a week by week basis.

Health Related Quality of Life Significance of Single Pad Urinary Incontinence Following Radical Prostatectomy

Continence outcomes after radical prostatectomy are frequently reported as the proportion of men using 1 urinary pad or less daily. We postulated that under appreciated health related quality of life (HRQOL) differences may exist between patients requiring 1 pad daily and those who do not require pads. A total of 168 patients who underwent radical prostatectomy performed by a single surgeon in a 2-year period were surveyed at a mean of 75 +/- 30 weeks postoperatively using the urinary function and bother scales of the University of California-Los Angeles Prostate Cancer Index (PCI), the American Urological Association symptom index and a question assessing satisfaction. To establish patient groups the levels of the PCI question assessing pad use were redefined to 0, 1, or 2 or greater pads daily. The remaining 4 urinary function questions were used to calculate the summary function score. Of the patients 146 (86.9%) reported no pad use and 20 (11.9%) used 1 pad daily. The mean function score +/-SD was 81.7 +/- 19.5 and 51.5 +/- 26.5 for the no and 1 pad groups, respectively (p <0.0001). The mean bother score was 86.8 +/- 18.8 and 54.2 +/- 30.0 (p <0.0001). There were sharp differences between the 2 groups for each of the individual PCI questions and for the satisfaction question but no differences in American Urological Association symptom index scores. We noted significant differences in urinary HRQOL between patients who do not require urinary pads after surgery and those who use a single pad daily across several domains of urinary function and bother. We believe that these findings underscore the need for more comprehensive HRQOL assessment in urinary outcome assessment after prostatectomy.

Long-term Safety and Efficacy of Tamsulosin for the Treatment of Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia

We evaluated the long-term (up to 6 years) safety and efficacy of the selective alpha 1A-adrenoceptor antagonist tamsulosin in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia. A total of 609 patients were enrolled in a 4-year multicenter open label extension study. Subjects entered the study after completion of a 1-year open label trial that included patients who previously completed up to 57 weeks of double-blind, placebo controlled studies. Maintenance doses (0.4 or 2 x 0.4 mg daily) established in the 1-year study were continued. Efficacy and safety were assessed every 3 months. Primary efficacy evaluations were changes from baseline maximum urine flow rate and total American Urological Association symptom index, and the responder rates for those 2 end points. Secondary end points were changes in American Urological Association subset scores, Boyarsky symptom scores, average urine flow rate, post-void residual urine volume, quality of life index and investigator global assessment. Of the 609 patients who entered the 4-year extension study 159 had a 2-year or greater prior experience with tamsulosin, yielding a potential 6-year experience on the medication. Of this 159 patient subset 109 completed the whole 6 years. Initial rapid improvements from baseline in primary and secondary end points were maintained each year throughout the duration of the study. Tamsulosin was well tolerated, confirming the safety profile demonstrated in earlier studies. Orthostatic hypotension was observed in 1.3% of the patients. This study demonstrates the sustained efficacy, safety and excellent long-term tolerability of tamsulosin for up to 6 years in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia.

American Urological Association Symptom Index for lower urinary tract symptoms in women: correlation with degree of bother and impact on quality of life

ObjectivesTo determine first whether the American Urological Association Symptom Index (AUASI) correlates with the degree of bother caused by lower urinary tract symptoms (LUTS) in women and whether the association varies with a woman’s age and continent status; and second, whether the AUASI and degree of bother caused by symptoms correlate with a woman’s quality of life (QOL) and whether the association varies with a woman’s age and continent status. LUTS occur in women and may produce significant bother and affect their QOL. The AUASI has been used to evaluate LUTS in female patients; however, its correlation with the degree of bother and QOL has not been clearly established in women. MethodsThe charts of 1232 women who completed the AUASI, as well as the Symptom Problem Index and global QOL question, were reviewed. Spearman’s rank order correlation was computed to assess the correlation between the AUASI and Symptom Problem Index. It was also computed after stratifying the women’s age and continence status (continent versus incontinent). A linear regression model was applied, with the AUASI and Symptom Problem Index as the response variables and QOL as the continuous explanatory variable. ResultsThe mean age was 54.6 years. Six hundred women (49%) were incontinent. Spearman’s rank order showed a strong correlation between symptoms and problems caused by symptoms (0.858, P <0.0001). The correlation existed throughout various age groups and was independent of coexisting incontinence. The symptoms correlated with QOL in a similar pattern. ConclusionsThe AUASI accurately described LUTS in women and, as with men, is a good indicator of the degree of bother and affect on QOL.

Comparison of lower urinary tract symptom severity and associated bother between community-dwelling black and white men: the Olmsted County Study of Urinary Symptoms and Health Status and the Flint Men’s Health Study

ObjectivesTo determine the magnitude of racial disparity in lower urinary tract symptom (LUTS) severity and bother by combining two large comparable epidemiologic studies of community-dwelling white and black men, thereby avoiding many of the referral biases present in previous studies. Prior studies evaluating racial differences in benign prostatic hyperplasia have been hampered by selection bias, because nearly all have used surgical treatment as a marker for benign prostatic hyperplasia. MethodsData from the Olmsted County Study of Urinary Symptoms and Health Status and the Flint Men’s Health Study were combined for a total study sample of 2480 men. We examined LUTS severity and associated bother as measured by the self-administered American Urological Association Symptom Index and Symptom Problem Index. ResultsOverall 34% of white men reported moderate/severe LUTS compared with 41% of black men (P <0.001). These patterns were consistent across age and persisted after adjustment for age and other sociodemographic factors. The relationship between LUTS severity and bother differed by race in that black men reported less bother for each unit increase in LUTS (P <0.001). ConclusionsIn contrast to studies based on clinical populations, our community-based study demonstrated greater LUTS severity in black men compared with white men but black men reported less bother for any given level of LUTS severity. Although these findings suggest a racial disparity in benign prostatic hyperplasia, additional studies of anatomic, physiologic, and molecular factors may clarify whether these racial differences are real or due to sociocultural differences in reporting symptom morbidity.

Problems with prostate specific antigen screening for prostate cancer in the primary healthcare setting in South Africa.

To assess the feasibility of detecting early-stage prostate cancer in the primary healthcare setting, and to investigate whether there is a higher incidence of prostate cancer in Black African men. The study was a collaboration with registrars in the authors' institutions and primary healthcare centres serving mainly a Black African or mixed ancestry (Coloured) population in the semi-urban Cape Town metropolitan area of South Africa. Men aged 50-70 years attending the clinics were counselled about prostate cancer and invited to have a digital rectal examination (DRE), serum prostate-specific antigen (PSA) assay and transrectal ultrasonography-guided sextant prostate biopsy if the DRE was clinically suspicious of malignancy or the serum PSA was > or = 4.0 ng/mL. An American Urological Association Symptom Index (AUA-SI) was obtained, and urine analysed using dipsticks. From May 2000 to November 2001, 660 men were assessed (mean age 59.4 years, range 30-82); 60.6% were Black African, 37.3% mixed (Coloured), 1.8% White (Caucasian) and 0.2% Asian (Indian). The mean (range) AUA-SI was 5.98 (0-35) in the whole group; the DRE was recorded as clinically suspicious of malignancy in 3.2%. The mean PSA was 20.39 (0.04-10 000) ng/mL in the whole group, but when two outliers (1865 and 10 000 ng/mL) were disregarded, it was 2.4 ng/mL. In Black patients the mean PSA was 31.8 (0.04-10 000) ng/mL, and without the outliers, 2.1 ng/mL; in Coloured patients it was 2.94 (0.05-50) ng/mL. The PSA was > or = 4.0 ng/mL in 9.6% of the whole group, in 7.8% of Black and in 13% of Coloured patients. Prostate biopsies were taken in 21 patients (3.2% of the whole group and a third of those with a PSA of > or = 4.0 ng/mL); in Black patients, biopsies were taken in 1.5% and 19.4%, respectively, and in Coloured patients in 6.1% and 46.9%, respectively. The prostate biopsy showed cancer in 43% of the whole group, in a third of Black and in 47% of Coloured patients; prostate cancer was detected in 1.4%, 0.5% and 2.8%, respectively. That prostate biopsies were obtained in only 19% of Black and in only 47% of Coloured men with a serum PSA of > or = 4.0 ng/mL is of concern. This indicates that there is a significant problem in getting men with an elevated serum PSA level to undergo a prostate biopsy in the primary healthcare setting in South Africa.

Cancer Fear and Mood Disturbance After Radical Prostatectomy: Consequences of Biochemical Evidence of Recurrence

Biochemical recurrence of prostate cancer often precedes any clinical sign or symptom of disease recurrence by several years. Thus, patients may have laboratory evidence of recurrence and do not know what it portends in terms of the future disease course. Little is known about the emotional consequences of biochemical recurrence. We compared cancer fear and mood disturbance in men with biochemical recurrence of prostate cancer versus those without recurrence. In addition, associations among urinary symptoms, cancer fear and mood disturbance were examined. A survey including the American Urological Association symptom index, a cancer fear measure and the Profile of Mood States was mailed to patients at a urology clinic at a tertiary care hospital in 1999. Of the sample of 270 patients with prostate cancer who underwent radical prostatectomy 126 (47%) responded to the mailed survey. A total of 45 men with biochemical prostate cancer recurrence were compared to 81 patients without recurrence. Higher urinary tract symptoms were associated with increased cancer fear and mood disturbance (each p <0.05). Biochemical cancer recurrence was not independently associated with increased cancer fear and mood disturbance. However, men with biochemical recurrence and more severe urinary tract symptoms reported the highest levels of cancer fear and mood disturbance (each p <0.01). Psychological distress was highest in men with biochemical recurrence and elevated clinical symptoms. Urinary symptoms may be an important contributor to psychological distress in patients with prostate cancer who have biochemical recurrence.

Prospective Evaluation of the American Urological Association Symptom Index and Peak Urinary Flow Rate for the Followup of Men With Known Urethral Stricture Disease

We prospectively evaluated the American Urological Association (AUA) symptom index and maximum urine flow for predicting urethral stricture recurrence in men with a previous diagnosis of urethral stricture disease. Patients were recruited at our urethral stricture clinic, where all newly diagnosed and previously treated men with urethral stricture present and are treated. The AUA symptom index was completed and uroflowmetry was done. The stricture was calibrated using Jacques catheters. If an 18Fr catheter could not be passed, a retrograde urethrogram was performed. Patients were treated with filiform dilation or direct vision internal urethrotomy. Uroflowmetry was repeated when the catheter was removed 3 days later and the AUA symptom index was repeated 1 month later. Data on 49 patients (170 consultations) between March 2000 and August 2001 were analyzed. Average patient age was 48 years. There was a significant negative correlation of urethral diameter with AUA symptom index and of AUA symptom index with maximum urine flow as well as a significant positive correlation of urethral diameter with maximum urine flow. We evaluated the usefulness of AUA symptom index and maximum urine flow at different cutoff levels for predicting urethral stricture in our study group. Using an AUA symptom index of greater than 10 or maximum urine flow of less than 15 ml. per second as cutoff values provided 93% sensitivity, 68% specificity, 78% positive predictive value, 89% negative predictive value and 82% overall accuracy. This method could have prevented further invasive studies in 34% of patients, while a clinically significant stricture would have been missed in only 4.3%. AUA symptom index combined with maximum urine flow is an accurate, time-saving and cost-effective tool for predicting recurrent stricture in patients with a known urethral stricture. It can be used to direct decision making on further invasive studies and treatment.

Prospective Evaluation of the American Urological Association Symptom Index and Peak Urinary Flow Rate for the Followup of Men With Known Urethral Stricture Disease

Prospective Evaluation of the American Urological Association Symptom Index and Peak Urinary Flow Rate for the Followup of Men With Known Urethral Stricture Disease