Lower urinary tract symptoms in an older man

Vedanayagam, Maria; Kumar, Amit; Madaan, Sanjeev

doi:10.1136/bmj.j1493

Cited by 5 publications

(6 citation statements)

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“…PSA does have some utility for symptomatic patients as a marker of prostate cancer [ 36 ], although some caution is needed. PSA levels can be raised by a number of benign conditions, including BPH, prostatitis, ejaculation, and exercise (false positive).…”

Section: Investigationsmentioning

confidence: 99%

Prostate Cancer in Primary Care

2018

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Prostate cancer is a common malignancy seen worldwide. The incidence has risen in recent decades, mainly fuelled by more widespread use of prostate-specific antigen (PSA) testing, although prostate cancer mortality rates have remained relatively static over that time period. A man’s risk of prostate cancer is affected by his age and family history of the disease. Men with prostate cancer generally present symptomatically in primary care settings, although some diagnoses are made in asymptomatic men undergoing opportunistic PSA screening. Symptoms traditionally thought to correlate with prostate cancer include lower urinary tract symptoms (LUTS), such as nocturia and poor urinary stream, erectile dysfunction and visible haematuria. However, there is significant crossover in symptoms between prostate cancer and benign conditions affecting the prostate such as benign prostatic hypertrophy (BPH) and prostatitis, making it very challenging to distinguish between them on the basis of symptoms. The evidence for the performance of PSA in asymptomatic and symptomatic men for the diagnosis of prostate cancer is equivocal. PSA is subject to false positive and false negative results, affecting its clinical utility as a standalone test. Clinicians need to counsel men about the risks and benefits of PSA testing to inform their decision-making. Digital rectal examination (DRE) by primary care clinicians has some evidence to show discrimination between benign and malignant conditions affecting the prostate. Patients referred to secondary care for diagnostic testing for prostate cancer will typically undergo a transrectal or transperineal biopsy, where a number of samples are taken and sent for histological examination. These biopsies are invasive procedures with side effects and a risk of infection and sepsis, and alternative tests such as multiparametric magnetic resonance imaging (mpMRI) are currently being trialled for their accuracy and safety in diagnosing clinically significant prostate cancer.

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Section: Investigationsmentioning

confidence: 99%

Prostate Cancer in Primary Care

2018

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“…nocturia, frequency, urgency) and voiding symptoms (e.g. hesitancy, intermittency, weak stream) 9 . LUTS are common in men with PCa, which may exacerbate bladder outflow obstruction 10 .…”

Section: Introductionmentioning

confidence: 99%

Triptorelin therapy for lower urinary tract symptoms (LUTS) in prostate cancer patients: A systematic meta‐analysis

Barrett,

Birch

2023

BJUI Compass

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ObjectiveThis systematic meta‐analysis aimed to assess the effectiveness of triptorelin therapy in reducing lower urinary tract symptoms (LUTS) in men with prostate cancer (PCa).MethodsThe Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed. PubMed, Web of Science and EMBASE databases were searched for studies conducted between 2013 and 2023. Eligible studies included PCa patients undergoing androgen deprivation therapy (ADT) with triptorelin, with reported baseline and follow‐up International Prostate Symptom Scores (IPSS) and quality of life (QoL) data. The Newcastle–Ottawa Scale (NOS) was used to assess the risk of bias, and a random‐effects model was applied for the meta‐analysis.ResultsA total of 29 articles were identified, and three studies met the inclusion criteria. Triptorelin therapy showed a clinically significant reduction in IPSS over 48 weeks in PCa patients with moderate to severe LUTS. The meta‐analysis revealed a pooled effect size of 1.05 (95% CI: 0.65; 1.45), indicating a statistically significant improvement in LUTS. QoL also improved in patients receiving triptorelin therapy, although heterogeneity among the studies and a moderate to high risk of bias were noted.ConclusionTriptorelin therapy demonstrated a positive impact on LUTS in PCa patients. The meta‐analysis showed significant reductions in IPSS scores and improved QoL after 48 weeks of triptorelin treatment. However, the results should be interpreted cautiously due to study heterogeneity and potential biases. Further well‐designed studies are needed to confirm these findings and determine the optimal use of triptorelin for managing LUTS in men with PCa.Implications for PracticeTriptorelin therapy may offer an effective treatment option for men with PCa experiencing moderate to severe LUTS. Its positive impact on QoL can lead to improved patient well‐being and treatment adherence. Clinicians should consider triptorelin as a potential treatment choice, especially in patients who may be reluctant to undergo surgical interventions for their LUTS. However, careful patient selection and close monitoring are essential due to the observed study heterogeneity and risk of bias. Future research should focus on evaluating triptorelin's cost‐effectiveness and comparing its efficacy with other LH‐RH agonists in managing LUTS in PCa patients.Video Abstract: URL (Reviewers/Editors to select from) Link 1: https://brighton.cloud.panopto.eu/Panopto/Pages/Viewer.aspx?id=071419c8-1ad5-4502-a222-b04300c2ca5eLink 2: https://brighton.cloud.panopto.eu/Panopto/Pages/Viewer.aspx?id=b6305a8a-b977-4fcd-a69e-b04300bed728

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“…LUTS can be caused by a local disease or injury in the lower urinary tract, such as urinary tract infection, prostatitis, urethral stricture, and bladder stones. In addition, numerous clinical and epidemiological studies have demonstrated that LUTS are common in aging and aging-related major chronic diseases and conditions (4,(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Oxidative Stress: A Putative Link Between Lower Urinary Tract Symptoms and Aging and Major Chronic Diseases

Elrashidy

et al. 2022

Front. Med.

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Aging and major chronic diseases are risk factors for lower urinary tract symptoms (LUTS). On the other hand, oxidative stress (OS) is one of the fundamental mechanisms of aging and the development of chronic diseases. Therefore, OS might be a candidate mechanism linking these two clinical entities. This article aims to summarize the studies on the prevalence of LUTS, the role of OS in aging and chronic diseases, and the potential mechanisms supporting the putative link. A comprehensive literature search was performed to identify recent reports investigating LUTS and OS in major chronic diseases. In addition, studies on the impact of OS on the lower urinary tract, including bladder, urethra, and prostate, were collected and summarized. Many studies showed LUTS are prevalent in aging and major chronic diseases, including obesity, metabolic syndrome, diabetes, cardiovascular disease, hypertension, obstructive sleep apnea, autoimmune diseases, Alzheimer’s disease, and Parkinson’s disease. At the same time, OS is a key component in the pathogenesis of those chronic diseases and conditions. Recent studies also provided evidence that exacerbated OS can cause functional and/or structural changes in the bladder, urethra, and prostate, leading to LUTS. The reviewed data support the concept that OS is involved in multiple risk factors-associated LUTS, although further studies are needed to confirm the causative relationship. The specific ROS/RNS and corresponding reactions/pathways involved in chronic diseases and associated LUTS should be identified in the future and could serve as therapeutic targets.

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Lower urinary tract symptoms in an older man

Cited by 5 publications

References 4 publications

Prostate Cancer in Primary Care

Prostate Cancer in Primary Care

Triptorelin therapy for lower urinary tract symptoms (LUTS) in prostate cancer patients: A systematic meta‐analysis

Oxidative Stress: A Putative Link Between Lower Urinary Tract Symptoms and Aging and Major Chronic Diseases

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