Department of Urology, University of South Florida College of Medicine, Tampa, Florida.
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; Department of Urology, Durham Veterans Affairs Medical Center, Durham, North Carolina.
J Urol. 2017 Sep;198(3):650-656. doi: 10.1016/j.juro.2017.04.075. Epub 2017 Apr 17.
We determined whether decreased peak urine flow is associated with future incident lower urinary tract symptoms in men with mild to no lower urinary tract symptoms.
Our population consisted of 3,140 men from the REDUCE (Reduction by Dutasteride of Prostate Cancer Events) trial with mild to no lower urinary tract symptoms, defined as I-PSS (International Prostate Symptom Score) less than 8. REDUCE was a randomized trial of dutasteride vs placebo for prostate cancer prevention in men with elevated prostate specific antigen and negative biopsy. I-PSS measures were obtained every 6 months throughout the 4-year study. The association between peak urine flow rate and progression to incident lower urinary tract symptoms, defined as the first of medical treatment, surgery or sustained and clinically significant lower urinary tract symptoms, was tested by multivariable Cox models, adjusting for various baseline characteristics and treatment arm.
On multivariable analysis as a continuous variable, decreased peak urine flow rate was significantly associated with an increased risk of incident lower urinary tract symptoms (p = 0.002). Results were similar in the dutasteride and placebo arms. On univariable analysis when peak flow was categorized as 15 or greater, 10 to 14.9 and less than 10 ml per second, flow rates of 10 to 14.9 and less than 10 ml per second were associated with a significantly increased risk of incident lower urinary tract symptoms (HR 1.39, p = 0.011 and 1.67, p <0.001, respectively). Results were similar on multivariable analysis, although in the 10 to 14.9 ml per second group findings were no longer statistically significant (HR 1.26, p = 0.071).
In men with mild to no lower urinary tract symptoms a decreased peak urine flow rate is independently associated with incident lower urinary tract symptoms. If confirmed, these men should be followed closer for incident lower urinary tract symptoms.
我们旨在确定轻度至无下尿路症状男性的最大尿流率降低是否与未来下尿路症状的发生有关。
我们的研究人群包括来自 REDUCE（度他雄胺降低前列腺癌事件）试验的 3140 名男性，这些男性有轻度至无下尿路症状，定义为国际前列腺症状评分（I-PSS）小于 8。RE- DUCE 是一项针对前列腺特异性抗原升高和前列腺活检阴性的男性的度他雄胺与安慰剂预防前列腺癌的随机试验。在整个 4 年的研究中，每 6 个月测量一次 I-PSS。使用多变量 Cox 模型测试最大尿流率与发生下尿路症状事件（定义为首次接受药物治疗、手术或持续且具有临床意义的下尿路症状）的关联，调整了各种基线特征和治疗组。
在多变量分析中，最大尿流率作为连续变量，与下尿路症状事件的发生风险增加显著相关（p=0.002）。在度他雄胺和安慰剂组中结果相似。在单变量分析中，当最大尿流率分为 15ml 或更高、10-14.9ml 和小于 10ml/s 时，10-14.9ml/s 和小于 10ml/s 的最大尿流率与下尿路症状事件的发生风险显著增加相关（风险比 1.39，p=0.011 和 1.67，p<0.001）。在多变量分析中结果相似，尽管在 10-14.9ml/s 组中结果不再具有统计学意义（风险比 1.26，p=0.071）。
在轻度至无下尿路症状的男性中，最大尿流率降低与下尿路症状事件的发生独立相关。如果得到证实，这些男性应该更密切地随访下尿路症状事件的发生。
