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Clinical Research

Lifestyle and health factors associated with progressing and remitting trajectories of untreated lower urinary tract symptoms among elderly men

Prostate Cancer and Prostatic Diseases volume 17, pages 265–272 (2014)Cite this article

Subjects

Abstract

Background:

Knowledge of factors associated with the course of lower urinary tract symptoms (LUTS) before treatment is needed to inform preventive interventions. In a prospective study of elderly men untreated for LUTS, we identified factors associated with symptom progression and remission.

Methods:

In community-dwelling US men aged ⩾65 years, the American Urological Association Symptom Index (AUA-SI) was repeated four times, once at baseline (2000–2002) and then every 2 years thereafter. Analyses included 1740 men with all four AUA-SI assessments, who remained free from diagnosed prostate cancer, and who reported no treatment for LUTS or BPH during follow-up that averaged 6.9 (±0.4) years. LUTS change was determined with group-based trajectory modelingof the repeated AUA-SI measures. Multivariable logistic regression was then used to determine the baseline factors associated with progressing compared with stable trajectories, and with remitting compared with progressing trajectories. Lifestyle, body mass index (BMI) (kg/m2), mobility, mental health (Short-Form 12), medical history and prescription medications were considered for selection. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for variables in each model.

Results:

We identified 10 AUA-SI trajectories: 4 stable (1277 men, 73%), three progressing (345 men, 20%), two remitting (98 men, 6%) and one mixed (20 men, 1%). Men in progressing compared with stable trajectories were more likely to have mobility limitations (OR=2.0, 95% CI: 1.0–3.8), poor mental health (OR=1.9, 95% CI: 1.1–3.4), BMI⩾25.0 kg m−2 (OR=1.7, 95% CI: 1.0–2.8), hypertension (OR=1.5, 95% CI: 1.0–2.4) and back pain (OR=1.5, 95% CI: 1.0–2.4). Men in remitting compared with progressing trajectories more often used central nervous system medications (OR=2.3, 95% CI: 1.1–4.9) and less often had a history of problem drinking (OR=0.4, 95% CI: 0.2–0.9).

Conclusions:

Several non-urological lifestyle and health factors were independently associated with risk of LUTS progression in older men.

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Acknowledgements

This work was supported by the National Institute for Diabetes and Digestive and Kidney Diseases (Grant R21 DK083675 to LMM and JKP). The MrOS Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS) and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160 and UL1 TR000128.

Author information

Author notes

  1. L M Marshall, K F Holton, J K Parsons and J A Lapidus: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA

    L M Marshall

  2. Department of Public Health and Preventive Medicine, Oregon Health and Science, Portland, OR, USA

    L M Marshall, J A Lapidus & K Ramsey

  3. Department of Medicine, Bone and Mineral Unit, Oregon Health and Science University, Portland, OR, USA

    L M Marshall

  4. Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, USA

    K F Holton

  5. Division of Urology, University of California San Diego, La Jolla, CA, USA

    J K Parsons

  6. Moores Cancer Center, University of California San Diego, La Jolla, CA, USA

    J K Parsons

  7. Department of Surgery, San Diego Veterans Affairs Medical Center, La Jolla, CA, USA

    J K Parsons

  8. Biostatistics Design Program, Oregon Clinical and Translational Research Institute, Oregon Health and Science University, Portland, OR, USA

    J A Lapidus & K Ramsey

  9. Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA

    E Barrett-Connor

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for the Osteoporotic Fractures in Men (MrOS) Study Group

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Correspondence to L M Marshall.

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Competing interests

Dr Parsons and Dr Marshall received funding as co-Principal Investigators for this research from the US National Institutes of Health under grant R21 DK083675. Dr Parsons also reports relationships with AMS and Sophiris outside the submitted work. All other authors declare no conflict of interests.

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Marshall, L., Holton, K., Parsons, J. et al. Lifestyle and health factors associated with progressing and remitting trajectories of untreated lower urinary tract symptoms among elderly men. Prostate Cancer Prostatic Dis 17, 265–272 (2014). https://doi.org/10.1038/pcan.2014.22

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