Olmsted County Study Research Articles

Association of Urinary MyProstateScore, Age, and Prostate Volume in a Longitudinal Cohort of Healthy Men: Long-term Findings from the Olmsted County Study

BackgroundSerum prostate-specific antigen (PSA), used in prostate cancer screening, is nonspecific for cancer and is affected by age and prostate volume. More specific biomarkers could be more accurate for early detection of prostate cancer and reduce unnecessary prostate biopsies. ObjectiveTo evaluate the association of age and prostate volume with urinary MyProstateScore (MPS) in a screened, longitudinal cohort without evidence of prostate cancer. Design, setting, and participantsThe Olmsted County Study included men aged 40–79 yr who underwent biennial prostate cancer screening. PSA ≥4.0 ng/ml or abnormal rectal examination triggered prostate biopsy, and patients with cancer were excluded. The remaining men submitted urinary specimens for PCA3 and TMPRSS2:ERG testing. Outcome measurements and statistical analysisMPS was calculated using the validated, locked model for grade group ≥2 cancer that includes serum PSA, urinary PCA3, and urinary TMPRSS2:ERG. The associations of age and volume with biomarkers were assessed in multivariable regression models. The t statistic was used to quantify the strength of associations independent of the unit of measurement, and R2 values were used to estimate the proportion of biomarker variance explained by each factor. Results and limitationsThe study included 314 screened men without evidence of cancer. In multivariable models including age and volume, PCA3 score was significantly associated with age (t = 7.51; p < 0.001), while T2:ERG score was not associated with age or volume. MPS was significantly associated with both age (t = 7.45; p < 0.001) and volume (t = 3.56; p < 0.001), but accounting for age alone explained the variability observed (R2 = 0.29) in a similar way to the model including age and volume (R2 = 0.31). The variability of PCA3, T2:ERG, and MPS was less dependent on age and volume than the variability for PSA (R2 = 0.45). ConclusionsIn a cohort of longitudinally screened men without evidence of cancer, we found that MPS demonstrated less variability with noncancer factors (age, prostate volume) than PSA did. These findings support the biology of these markers as more cancer-specific than PSA and highlight their promise in reducing the morbidity associated with PSA-based screening. Patient summaryIn a group of men with no evidence of prostate cancer, we found that each of three urine-based markers of cancer—PCA3, T2:ERG, and the commercially available MyProstateScore test—showed less variability with noncancer factors (age and prostate volume) than serum PSA (prostate-specific antigen) did. These findings support their proposed use as noninvasive markers of prostate cancer that could improve the accuracy of early detection.

Epidemiologic Factors, Clinical Presentation, Causes, and Outcomes of Liver Abscess: A 35-Year Olmsted County Study.

ObjectiveTo report the changing incidence, clinical presentation, microbiologic spectrum, and outcomes of pyogenic liver abscess (PLA) in Olmsted County, Minnesota, over the past 35 years.Patients and MethodsThe Rochester Epidemiology Project was used to identify residents with PLA from January 1, 1980, through December 31, 2014. The study included all patients older than 18 years, with the diagnosis of PLA confirmed through radiographic review and microbiologic cultures.ResultsIn total, 72 patients received a diagnosis of PLA from 1980 through 2014. The age-adjusted incidence for men was 3.92 cases per 100,000 person-years (95% CI, 2.76-5.09 cases per 100,000 person-years) compared with 1.87 cases per 100,000 person-years (95% CI, 1.15-2.59 cases per 100,000 person-years) for women. Incidence was higher in the period from January 1, 2001, through December 31, 2014, than in the period from January 1, 1980, through December 31, 2000, for women (incidence rate ratio [IRR], 3.8; 95% CI, 1.43-10.09; P=.007) but not for men (IRR, 0.99; 95% CI, 0.55-1.76; P=.96). Fifteen additional patients had postintervention PLA (1980-2000: n=3 of 29 [10.3%] vs 2001-2015: n=12 of 58 [20.6%]). A significant association was seen between age- and sex-adjusted incidence rates of PLA and year of diagnosis (per year since 1980: IRR, 1.04; 95% CI, 1.02-1.07; P<.001) after including postintervention PLA. Streptococcus milleri was the most common organism identified (52.5%). Organisms with multidrug resistance were more common in the period from 2001 through 2014 than in the period from 1980 through 2000 (51% vs 14%; P=.005). The overall mortality rate of PLA was 16.8% (95% CI, 7.6%-25.0%) at 6 months.ConclusionThe incidence of PLA is increasing, probably because of increase in frequency of hepatobiliary interventions and organisms with multidrug resistance.

Su1496 - Epidemiology, Clinical Presentation, Etiology and Outcomes of Liver Abscesses: A 35-Year Olmsted County Study

Su1496 - Epidemiology, Clinical Presentation, Etiology and Outcomes of Liver Abscesses: A 35-Year Olmsted County Study

Change in Sexual Function in Men with Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia Associated with Long-Term Treatment with Doxazosin, Finasteride and Combined Therapy

We examined the effects of doxazosin, finasteride and combined therapy in men with lower urinary tract symptoms associated with benign prostatic hyperplasia on sexual function, as assessed by the Brief Male Sexual Function Inventory during 4 years. The MTOPS (Medical Therapy of Prostatic Symptoms) study was a multicenter, randomized, double-blind, placebo controlled clinical trial with a primary outcome of time to benign prostatic hyperplasia progression. Change in sexual function was a secondary outcome. We analyzed the records of2,783 men enrolled in the study who completed the inventory at baseline and atleast once during followup. In men enrolled in MTOPS sexual function decreased with time. Men assigned to finasteride and combined therapy experienced overall statistically significant but slight worsening of ejaculatory function compared with men on placebo. Men assigned to combined therapy also experienced significant worsening in erectile function and sexual problem assessment. There was no significant difference in changes in any inventory domain in men assigned to doxazosin alone compared to placebo. This study significantly extends understanding of the effects of long-term treatment with these drugs on sexual function in men with lower urinary tract symptoms associated with benign prostatic hyperplasia. Treatment with finasteride or combined therapy was associated with worsening sexual function while treatment with doxazosin alone was associated with minimal negative impact, if any. Physicians should discuss with their patients the possible long-term effects of these drugs for lower urinary tract symptoms associated with benign prostatic hyperplasia on sexual function.

Racial Differences in Longitudinal Changes in Serum Prostate-specific Antigen Levels: The Olmsted County Study and the Flint Men's Health Study

To determine the distribution of, and racial differences in, changes in prostate-specific antigen (PSA) from a population-based sample of men. Data from 2 prospective cohort studies of a random sample of white men, aged 40-79 years in 1990, followed biennially through 2007, and African American men, aged 40-79 years in 1996, followed through 2000, were examined to assess the longitudinal changes in PSA concentrations. Serum PSA levels were determined at each examination for both cohorts and observations after a diagnosis of prostate cancer or treatment of benign prostatic hyperplasia were censored. The observed and estimated annual percentage of change in the serum PSA levels were examined by race. At baseline, the median PSA level in the white men did not differ from the median level observed in the African American men (white men 0.9 ng/mL; African American men 0.9 ng/mL; P= .48). However, African American men had a much more rapid increase in the PSA level over time compared with the white men (median annual percent change in PSA for white men 3.6%/y, African American men 7.9%/y; P<.001). These data suggest that African American men have more rapid rates of change in the PSA levelsover time. If the difference in the rate of changes between African American and white men is an early indicator of future prostate cancer diagnosis, earlier detection in African American men could help to alleviate the racial disparities in prostate cancer diagnosis and mortality.

Non‐steroidal anti‐inflammatory drug use and the risk of benign prostatic hyperplasia‐related outcomes and nocturia in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

Study Type - Therapy (cohort) Level of Evidence 4. What's known on the subject? and What does the study add? Accumulating evidence suggests that inflammation may contribute to the development of BPH and LUTS. Therefore, it is plausible that anti-inflammatory agents, such as aspirin and other NSAIDs, may reduce the risk of BPH/LUTS, as was observed in a recent analysis of daily aspirin use and BPH/LUTS risk in the Olmsted County Study of Urinary Symptoms and Health Status in Men. The present study, conducted in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, found no association for recent aspirin or ibuprofen use with the risk of BPH/LUTS. To investigate the relationship between non-steroidal anti-inflammatory drug (NSAID) use and the incidence of benign prostatic hyperplasia (BPH)-related outcomes and nocturia, a lower urinary tract symptom (LUTS) of BPH, in light of accumulating evidence suggesting a role for inflammation in BPH/LUTS development. At baseline, participants in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial completed questions on recent, regular aspirin and ibuprofen use, BPH surgery, diagnosis of an enlarged prostate/BPH, and nocturia. Participants in the intervention arm also underwent a digital rectal examination (DRE), from which prostate dimensions were estimated, as well as a prostate-specific antigen (PSA) test. Only participants in the intervention arm without BPH/LUTS at baseline were included in the analysis (n= 4771). • During follow-up, participants underwent annual DREs and PSA tests, provided annual information on finasteride use, and completed a supplemental questionnaire in 2006-2008 that included additional questions on diagnosis of an enlarged prostate/BPH and nocturia. • Information collected was used to investigate regular aspirin or ibuprofen use in relation to the incidence of six BPH/LUTS definitions: diagnosis of an enlarged prostate/BPH, nocturia (waking two or more times per night to urinate), finasteride use, any self-reported BPH/LUTS, prostate enlargement (estimated prostate volume ≥30 mL on any follow-up DRE) and elevation in PSA level (>1.4 ng/mL on any follow-up PSA test). Generally, null results were observed for any recent, regular aspirin or ibuprofen use (risk ratio = 0.92-1.21, P= 0.043-0.91) and frequency of use (risk ratios for one category increase in NSAID use = 0.98-1.11, P-trends = 0.10-0.99) with incident BPH/LUTS. The findings obtained in the present study do not support a protective role for recent NSAID use in BPH/LUTS development.

Diabetes Treatment and Progression of Benign Prostatic Hyperplasia in Community-dwelling Black and White Men

To conduct a study to determine whether diabetes treatment is associated with benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and progression in black and white men. Diabetes has been associated with BPH and LUTS in aging men. Using the Olmsted County Study of Urinary Symptoms and Health Status among Men and the Flint Men's Health Study, we examined how the use of medical therapy (eg, insulin regimens, oral hypoglycemics) related to changes in LUTS severity, maximal urinary flow rate measured by uroflowmetry, prostate volume determined by transrectal ultrasonography, and serum prostate-specific antigen concentrations. Of the 2226 men participating in the Olmsted County Study of Urinary Symptoms and Health Status among Men and the Flint Men's Health Study, 186 men reported a history of diabetes, 76.9% of whom were treated with medical therapy. Overall, the men with diabetes had significantly greater odds of moderate/severe LUTS (age- and race-adjusted odds ratio 1.37, 95% confidence interval 1.00-1.87) compared with those without diabetes. However, among the diabetic men, those not taking medication had greater odds of moderate/severe LUTS than those taking medication. This association among men not taking medication was seen for 5 of the 7 individual symptoms. The prostate volume and prostate-specific antigen level were not significantly associated with diabetes treatment. No significant differences were observed for the annual change in BPH characteristics by diabetes treatment status. These findings suggest that the presence of diabetes and subsequent poor glycemic control might be less related to prostate growth and more to the dynamic components of lower urinary tract function. Additional evaluations of the associations between glycemic control and BPH progression are warranted.

Distribution and Associations of [−2]Proenzyme-Prostate Specific Antigen in Community Dwelling Black and White Men

We provide cross-sectional normative data on [-2]proenzyme-prostate specific antigen from the Olmsted County Study of Urinary Symptoms and Health Status among Men, and the Flint Men's Health Study. We also describe associations with clinical urological measures and the risk of prostate cancer diagnosis. Measurements of [-2]proenzyme-prostate specific antigen were obtained from 420 white men from Olmsted County, Minnesota, and 328 black men from Genesee County, Michigan. Cross-sectional associations between [-2]proenzyme-prostate specific antigen and prostate enlargement/elevated prostate specific antigen were assessed. Cox proportional hazard models were used to assess associations between [-2]proenzyme-prostate specific antigen and the incident diagnosis of prostate cancer. Baseline [-2]proenzyme-prostate specific antigen was slightly higher in black men at a median of 6.3 pg/ml (25th, 75th percentiles 4.1, 8.9) than in white men at a median of 5.6 pg/ml (25th, 75th percentiles 3.9, 7.7, respectively, p = 0.01). Baseline [-2]proenzyme-prostate specific antigen was highly predictive of biopsy confirmed prostate cancer in the Olmsted County Study cohort. Relative to men in the [-2]proenzyme-prostate specific antigen lower quartile those in the upper quartile were at almost eightfold increased risk for prostate cancer (HR 7.8, 95% CI 2.2-27.8) after adjusting for age and baseline prostate specific antigen. In these cohorts of community dwelling black and white men [-2]proenzyme-prostate specific antigen was much lower than in previous studies. These data suggest that [-2]proenzyme-prostate specific antigen may help identify prostate cancer in men with serum prostate specific antigen in an indeterminate range, although the reference ranges for white and black men may differ slightly.

Associations Between Modest Weight Changes and Onset and Progression of Lower Urinary Tract Symptoms in Two Population-based Cohorts

To conduct a study to determine whether weight changes were associated with the risk of developing lower urinary tract symptoms (LUTS). Obesity has been associated with LUTS in aging men. The study population consisted of men participating in the Olmsted County Study of Urinary Symptoms and Health Status among Men and the Flint Men's Health Study. Weight loss and weight gain were defined as a change of ≥5% of the baseline weight. LUTS progression was measured by calculating the American Urological Association Symptom Index (AUASI) score slopes for 4 years of follow-up in both cohorts. Additional Cox proportional hazard models were constructed to determine whether the weight changes were associated with the later development of moderate-to-severe symptoms or with a ≥4-point increase in the AUASI score (Olmsted County Study of Urinary Symptoms and Health Status among Men cohort only). Weight changes were not associated with LUTS progression (all P > .05). Additionally, the rate at which the AUASI scores changed did not vary by the weight change. Finally, in the Olmsted County Study of Urinary Symptoms and Health Status among Men cohort, the weight changes were not associated with risk of having a moderate-to-severe AUASI score or a ≥4-point increase in the AUASI score. Modest weight loss might not prevent the onset or progression of LUTS. However, modest weight gain also might not contribute to changes in LUTS.

1722 ASSOCIATIONS BETWEEN MODEST WEIGHT LOSS AND ONSET AND PROGRESSION OF LOWER URINARY TRACT SYMPTOMS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Epidemiology and Natural History/Evaluation and Markers1 Apr 20111722 ASSOCIATIONS BETWEEN MODEST WEIGHT LOSS AND ONSET AND PROGRESSION OF LOWER URINARY TRACT SYMPTOMS Jennifer St. Sauver, Aruna Sarma, John Hollingsworth, Debra Jacobson, Michaela McGree, Rodney Dunn, Michael Lieber, and Steven Jacobsen Jennifer St. SauverJennifer St. Sauver Mayo Clinic, MN More articles by this author , Aruna SarmaAruna Sarma Ann Arbor, MI More articles by this author , John HollingsworthJohn Hollingsworth Ann Arbor, MI More articles by this author , Debra JacobsonDebra Jacobson Mayo Clinic, MN More articles by this author , Michaela McGreeMichaela McGree Mayo Clinic, MN More articles by this author , Rodney DunnRodney Dunn Ann Arbor, MI More articles by this author , Michael LieberMichael Lieber Mayo Clinic, MN More articles by this author , and Steven JacobsenSteven Jacobsen Pasadena, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1993AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Obesity has been associated with lower urinary tract symptoms (LUTS) in aging men, and weight loss has been proposed as a means to reduce or prevent LUTS. To test this hypothesis, we used information collected in two prospective cohort studies to determine if weight loss was associated with a decreased risk of developing moderate to severe LUTS in black and white men. METHODS The study population consisted of white men participating in the Natural History of Prostatism: The Olmsted County Study (OCS) and black men participating in the Flint Men's Health Study (FMHS). Change in weight between base-line and four years of follow-up was classified into three categories: no weight loss, loss of some weight (<5% of base-line weight), or loss of at least 5% of base-line weight. Corresponding changes in American Urological Association Symptom Index (AUASI) score over the four years of follow-up were characterized and compared across weight loss categories. In OCS men, Cox proportional hazards models were used to estimate the associations between weight loss and development of adverse outcomes, adjusting for potential confounders including baseline age, weight, diabetes, hypertension and exercise. RESULTS Weight loss was not associated with LUTS progression in black or white men (Table). Additionally, the rate at which AUASI scores changed did not vary by categories of weight loss (OCS p value=0.70; FMHS p value=0.54). Finally, in the OCS cohort, weight loss was not associated with risk of developing a moderate to severe AUASI score (>7) or receipt of treatment for benign prostatic hyperplasia or LUTS (all p values>0.05). Outcome No weight loss (N%) Lost < 5% of baseline weight Lost ⊗ of baseline weight (N%) Chi-square p value OCS No change in symptoms 170(13.34) 33(12.13) 10(7.81) 0.22 Decrease in symptoms 470(36.89) 111(40.81) 45(35.16) Increase in symptoms 634(49.76) 128(47.06) 73(57.03) FMHS No change in symptoms 9(9.78) 8(15.09) 2(10.53) 0.75 Decrease in symptoms 45(48.91) 24(45.28) 7(36.84) Increase in symptoms 38(41.30) 21(39.62) 10(52.63) CONCLUSIONS Modest weight loss may not prevent the onset or progression of LUTS in aging men. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e691-e692 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jennifer St. Sauver Mayo Clinic, MN More articles by this author Aruna Sarma Ann Arbor, MI More articles by this author John Hollingsworth Ann Arbor, MI More articles by this author Debra Jacobson Mayo Clinic, MN More articles by this author Michaela McGree Mayo Clinic, MN More articles by this author Rodney Dunn Ann Arbor, MI More articles by this author Michael Lieber Mayo Clinic, MN More articles by this author Steven Jacobsen Pasadena, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Effects of Type 2 Diabetes and Hypertension on Changes in Serum Prostate Specific Antigen Levels: Results From the Olmsted County Study

Men with type 2 diabetes have lower concomitant prostate-specific antigen (PSA) levels; however, the influence of metabolic conditions on PSA changes over time remains unknown. Therefore, the goal of this study was to assess associations between type 2 diabetes and hypertension and changes in serum PSA levels. In 1990, a randomly selected cohort of Caucasian men, ages 40-79, from Olmsted County, MN completed questionnaires ascertaining demographic characteristics, current medical conditions and medications biennially, with 633 men undergoing blood draws. Men with a physician diagnosis of diabetes or hypertension at baseline, or who reported using medications to treat these conditions prior to baseline were considered exposed. Men with at least two serum PSA measurements (n = 569) were included in this analysis. Linear mixed models were used to estimate the annual percent change in serum PSA levels associated with diabetes and hypertension, adjusting for baseline age. The overall mean change in serum PSA levels was 3.6% per year and increased with age (P = .009). Men with diabetes experienced less annual change in serum PSA levels (1.1%) than did non-diabetic men (3.7%), adjusting for age (P = .02). Age-adjusted change in serum PSA levels differed little by hypertension status (3.7% vs. 3.6%; P = .49). Our results suggest that Caucasian men with type 2 diabetes experience smaller increases in serum PSA levels as they age compared to men without diabetes. Additional research is needed to elucidate whether this difference results in a relatively lower incidence of prostate cancer or less cancer detection among diabetic men.

The effects of metabolic conditions on prostate cancer incidence over 15 years of follow‐up: results from the Olmsted County Study

• To determine if combinations of obesity, hypertension and diabetes influence the development of prostate cancer over 15 years of follow-up. • In 1990, a randomly selected cohort of Caucasian men from Olmsted County, MN, USA, aged 40-79 years, was recruited; 2445 completed a questionnaire that included physician-diagnosed diabetes and hypertension. • Anthropometric measures were collected during clinical examination. Biopsy-confirmed prostate cancer was identified from medical records. • Proportional hazards regression was used to estimate the effects of these metabolic conditions, both individually and in combination, on the incidence rate of prostate cancer. • Men with hypertension alone or in combination with diabetes were more likely to develop prostate cancer than were men without any of the metabolic conditions. • The metabolic syndrome - the presence of all three conditions compared with men with no metabolic components - was only minimally and inversely associated with prostate cancer [hazard ratio (HR): 0.81; 95% confidence interval (CI): 0.20, 3.3] and no monotonic association between the number of metabolic components and prostate cancer was observed. • Our results suggest that it may not be sufficient to treat metabolic conditions as one variable when investigating the aetiology of prostate cancer in Caucasian men. • Further research should focus on the separate and combined effects of these metabolic conditions in large samples.

Estimation of Prostate Size in Community-dwelling Men

To use two population-based samples of prostate cancer-free men to develop and validate a novel multivariable equation for estimating prostate volume (PV). Previous investigators have demonstrated the ability to use serum prostate-specific antigen (PSA) levels to estimate PV in men without prostate cancer; however, the ability of additional clinical variables to further enhance PV estimation in these men remains unclear. We applied linear regression modeling to data from an 80% random sample (n = 366) of the baseline cohort from the Olmsted County Study of Urinary Symptoms and Health Status among Men (OCS) to develop an equation for estimating PV in men without prostate cancer. We then evaluated the predictive ability of this equation by comparing estimated and measured PV values in 3 additional validation sets of men. The final linear regression model included PSA, age, and weight as independent predictors of PV. For prediction in baseline OCS men, the multiple correlation coefficients increased from 0.62(PSAalone) to 0.71(fullmodel). In addition, the area under the curve estimates from the receiver operating characteristic curves increased from 0.79(PSAalone) to 0.85(fullmodel) for predicting PV >30 mL. Our data suggest that PV can be estimated with easily obtained clinical variables. Moreover, we demonstrate that age and weight can be added to PSA level to achieve greater accuracy in predicting PV. This methodology may prove useful for estimating PV in men in settings where costs and practicality preclude the use of imaging techniques.

The aging male population and medical care for benign prostatic hyperplasia in Canada

The male Canadian population is aging and more men will be seeking medical care for benign prostatic hyperplasia (BPH). We examined the projected increase in older Canadian males between 2005 and 2018 to evaluate urologic health-care needs. We used Statistics Canada population projections to derive predictions of the male population aged 50 or more from 2005 to 2018 and results from the Olmsted County Study of Urinary Symptoms to estimate numbers of males aged >/=50 with moderate to severe lower urinary tract symptoms (msLUTS) in the same period. Data from the Canadian Institute for Health Information were used to estimate the number of urologists in 2018. The number of Canadian men aged >/=50 is projected to rise between 2005 and 2018 by 39.5% and the number with msLUTS by 41.3%. However, the number of practicing urologists in Canada in 2018 is likely to be similar to the 584 practicing in 2007. An increase in the number of urologists proportional to the increase in men aged >/=50 with msLUTS would require 799 urologists in 2018. Little opportunity exists to expand the number of trainees in urology. Other alternatives must be sought to deal with increased numbers of older men with msLUTS. Initial management of BPH has moved towards being a responsibility of primary care physicians, but they appear to view BPH as a quality-of-life issue. It is crucial that urologists work closely with primary care physicians to ensure that the management of LUTS progression is optimized.

Cardiovascular Disease Surveillance in the Comparative Effectiveness Landscape

As the leading cause of death in the Western world, cardiovascular disease (CVD) constitutes an enormous public health problem.1 The last 4 decades have been characterized chiefly by the postponement of CVD events and CVD related deaths until older age. Thus, the burden of CVD is increasing in parallel with the increase in life expectancy.2 Within this context, identifying persons with CVD, measuring its incidence and outcome and how these vary over time and across populations is essential. A central goal of this monitoring (otherwise termed surveillance) has been to understand the determinants of the trends in CVD and in particular the respective responsibility of primary prevention versus that of the care of established disease in the genesis of the CVD trends. A direct extension of surveillance is its application to assess the effectiveness of care and the response to interventions designed to improve the quality of care. Articles see pp 414, 475, and 508 Over the first year of its existence, the journal Circulation: Cardiovascular Quality and Outcomes published 3 important articles that illustrate the clinical relevance of surveillance and the applicability of trend studies to care improvement. The article by Lewsey et al constitutes a classic example of CVD surveillance.3 The authors present much needed data on recent (1986 to 2005) trends in the epidemiology of stroke indicating that age- and sex-specific incidence rates of fatal and nonfatal hospitalized strokes in Scotland declined in men from 235 (95% CI, 229 to 242) to 149 (144 to 154) and in women from 299 (292 to 306) to 182 (177 to 188). The decline in incidence of hospitalized stroke varied by age, but overall this equated to a relative reduction in the risk of stroke of 31% in men and 42% in women. Declines in the …

Longitudinal Evaluation of Sexual Function in a Male Cohort: The Olmsted County Study of Urinary Symptoms and Health Status among Men

The presence of erectile or ejaculatory dysfunction may indicate physical problems; however, individual perceptions (e.g., sexual satisfaction) may reflect the degree of concern about these changes. Long-term data showing how changes in multiple sexual function domains track together may be useful in understanding the importance of physical declines vs. sexual satisfaction. The aim of this study was to describe changes in sexual function among a population-based sample of aging men. A population-based cohort study using data from the Olmsted County Study of Urinary Symptoms and Health Status among Men. Sexual function was assessed biennially from 1996 to 2004 using a previously validated questionnaire in a random sample of 2,213 men. Changes in erectile function, libido, ejaculatory function, sexual problems, and sexual satisfaction. Overall, we observed declines in all of the sexual function domains, ranging from an annual decrease of 0.03 point per year for sexual satisfaction to an annual decrease of 0.23 point per year in erectile function. Moderate correlations were observed among all longitudinal changes in sexual function (range in age-adjusted r(s) = 0.14-0.43); however, significantly smaller correlations between changes in the functional domains and changes in sexual satisfaction and problem assessment were observed among older men (range in age-adjusted r(s) = 0.03-0.29). Overall, these results demonstrate that longitudinal changes in five sexual function domains change together over time in our community-based cohort. Erectile function, ejaculatory function, and sexual drive decrease over time with greater rates of decline for older men. However, older men may be less likely to perceive these declines as a problem and be dissatisfied. These data may prove helpful to patients and clinicians in understanding and discussing changes in multiple aspects of sexual function.

Psychosocial Predictors of Lower Urinary Tract Symptom Bother in Black Men: The Flint Men's Health Study

Despite the importance of lower urinary tract symptom related bother to health related quality of life and treatment use little is known about factors contributing to perceived bother. We examined associations between several psychosocial measures and lower urinary tract symptom related bother in a population based sample of black men. In 1996, 361 black men 40 to 79 years old from Genesee County, Michigan with no history of prostate cancer/surgery provided information on lower urinary tract symptom bother and several psychosocial factors, including perceived stress, social support, stressful life events, and self-rated physical and emotional health. Associations between these factors and perceived bother were examined, controlling for age and lower urinary tract symptom severity. Overall 39.3% of men reported moderate/severe lower urinary tract symptom related bother. Men with poor emotional health and low social support were 2.25 (95% CI 1.05, 4.85) and 2.89 (95% CI 1.14, 7.35) times more likely to report moderate and severe bother, respectively. No other psychosocial factors significantly impacted bother after adjusting for age and lower urinary tract symptom severity. In this population based study of black men poor emotional health and low social support were significantly associated with moderate/severe lower urinary tract symptom related bother after adjusting for age and lower urinary tract symptom severity, supporting the notion that urinary bother measures may capture somatic and psychological distress. These findings suggest that treating lower urinary tract symptoms alone may not completely ameliorate urinary bother if underlying emotional health and social support problems are not addressed. Further studies are warranted in racially diverse populations.

PROSTATE CANCER AND URINARY INCONTINENCE

INTRODUCTION AND OBJECTIVES: Urinary incontinence (UI) following prostate cancer (PCa) is common, and may vary depending on type of PCa treatment. Our objectives were to determine the proportion of UI occurring in men diagnosed with PCa, and to determine if type of PCa treatment was associated with UI. We examined these questions using data from the Olmsted County Study of Urinary Symptoms and Health Status among Men. METHODS: In 1990, a randomly selected cohort of white men, ages 40-79 years, from Olmsted County, Minnesota was assembled (55% participation; n=2447). Men were followed via biennial questionnaires through 2007. UI was classified as answering yes to questions on urinary leakage, use of bladder control items, diagnosis of incontinence, involuntary loss of urine, and/or a history of chronic UI. Community medical records were also reviewed to determine onset of biopsy-confirmed PCa and type of initial treatment for PCa. The proportion of PCa patients who reported incontinence was calculated for first and last follow-up following PCa diagnosis. Odds ratios (ORs) were calculated to assess the association between type of treatment (surgical vs non-surgical) and UI. Patients who had reported UI prior to their PCa diagnosis were excluded from the analyses. RESULTS: Overall, 225 (9%) men developed PCa, and 143 (64%) did not report UI prior to development of PCa and had questionnaire information available both preand post-cancer diagnosis. Of these men, 60 (42%) reported UI at the first follow-up after PCa diagnosis (median follow-up:1.0 years, interquartile range (IQR): 0.3, 1.6). At the last follow-up after PCa diagnosis, 51 (36%) reported UI (median followup: 6.1 years, IQR: 2.6, 9.4). Surgical treatment (n=77, 54%) was not significantly associated with UI at the first follow-up (age-adjusted OR: 1.2, 95% Confidence Interval (CI): 0.6, 2.7). However, surgical treatment was associated with UI after the last follow-up (age-adjusted OR: 2.5; 95% CI: 1.2, 5.3). CONCLUSIONS: These data indicate that urinary incontinence is indeed significant in patients after a diagnosis of PCa. Additionally, UI remains common even several years after PCa diagnosis, and is associated with surgical treatment. Appropriate management options therefore need to be actively discussed with these patients.

Severity of Myocardial Infarction

Cardiovascular disease constitutes a burden of epidemic proportion,1 and understanding its determinants is essential to designing effective interventions. Doing so requires the ability to track disease burden at the population level. In the United States, without national registries, community surveillance is the method of choice.2 Community surveillance studies are mostly retrospective by design, rely on diagnostic codes for case finding, and require a defined population in which events can be consistently and reliably captured and validated with standardized approaches. Applied to cardiovascular disease, community surveillance measures its burden in communities by tracking the incidence of events, their severity, and their mortality, thereby enabling the appraisal of the components of cardiovascular diseases in a given population.2 Because of the aforementioned methodological requirements, few surveillance studies exist in the United States. They include the Atherosclerosis Risk in Communities (ARIC) Study,3 the Minnesota Heart Survey,4 the Olmsted County Study,5 and the Worcester Heart Attack Study.6 The data from these studies indicate that, although deaths from coronary disease have declined, the incidence of myocardial infarction in the United States has remained mostly stable. Thus, the decline in mortality can be envisioned as reflecting an improvement in survival, which may be mediated by a declining severity of myocardial infarction. Article p 503 The article by Myerson et al7 in this issue of Circulation specifically addresses this important and understudied issue in ARIC between 1987 and 2002. They examined a large, multiracial population and relied on several indicators, including the composite Predicting Risk of Death in Cardiac Disease Tool (PREDICT) score to conclude that the severity of infarction declined over time. Indeed, the proportion of infarctions with major ECG abnormalities, ST-segment elevation, and Q waves decreased, as did biomarker values and the proportion of persons presenting with shock. …

Psychosocial Factors Associated with an Increased Frequency of Prostate Cancer Screening in Men Ages 40 to 79 Years: The Olmsted County Study

Prostate cancer is the second leading cause of cancer deaths among U.S. men. Early detection is associated with drastically improved 5-year survival rates. It is unclear, however, what psychosocial factors motivate or discourage men from taking advantage of both prostate-specific antigen (PSA) testing and digital rectal examination (DRE). The goal of the current study was to identify psychosocial factors that influence screening behavior for prostate cancer in a cohort of 2,447 men. In 1990, a randomly selected cohort of Caucasian men, ages 40 to 79 years, from Olmsted County, Minnesota, were enrolled in the study. These men completed a questionnaire containing queries on family history of prostate cancer, concern about getting prostate cancer, and marital status. Medical and laboratory records were reviewed to determine the number DREs (1989-1996) and PSA tests (1989-1998). Frequent screening was defined as the upper 25th percentile for number of DREs (>4) or PSAs (>3). Men who have a family history and men who worry or have concern about prostate cancer were more likely [odds ratio (OR), 1.5; 95% confidence interval (95% CI), 1.2-2.0 and OR, 1.9; 95% CI, 1.4-2.5] to seek screening compared with those without a family history or worry. The association between family history and frequent screening was similar in men who were married or living with someone (OR, 1.7; 95% CI, 1.2-2.2); however, it was reduced among men who live alone (OR, 0.6; 95% CI, 0.2-1.8). These data suggest that psychosocial factors such as family history, worry, or concern about prostate cancer and marital status may play an important role in men's decisions about prostate cancer screening.