Biomedical subjects

Debra J Jacobson

Publications and source records attributed to Debra J Jacobson.

At least 19 recordsLinked to original sources

PubMed2006

Protective association between nonsteroidal antiinflammatory drug use and measures of benign prostatic hyperplasia.

In 1990-2002, the authors conducted a population-based cohort study of 2,447 Caucasian men in Olmsted County, Minnesota, to determine whether daily users of nonsteroidal antiinflammatory drugs (NSAIDs) were at lower risk than nondaily NSAID users of developing benign prostatic hyperplasia. Participants completed validated questionnaires during a home visit, including information about daily NSAID use. A random subset of 634 men also participated in a clinical evaluation including transrectal ultrasonography and assessment of serum prostate-specific antigen levels. Examinations and questionnaires were repeated biennially through 2002. Benign prostatic hyperplasia measures included development of moderate/severe urinary symptoms (American Urological Association Symptom Index score >7), low maximum urinary flow rate (<12 ml/second), prostate volume >30 ml, or prostate-specific antigen level >1.4 ng/ml. After adjustment for age, daily NSAID use was inversely associated with onset of moderate/severe urinary symptoms (hazard ratio (HR) = 0.73, 95% confidence interval (CI): 0.64, 0.82), low maximum flow rate (HR = 0.51, 95% CI: 0.43, 0.61), increased prostate volume (HR = 0.53, 95% CI: 0.41, 0.68), and elevated prostate-specific antigen level (HR = 0.52, 95% CI: 0.40, 0.68). In age-specific analyses, inverse associations between NSAID use and urinary measures tended to be stronger in the oldest age groups, although this interaction was statistically significant for only obstructive symptoms and treatment. Results suggest that NSAID use may prevent or delay development of benign prostatic hyperplasia.

Adult↗

PubMed2006

Association of anthropometric measures with the presence and progression of benign prostatic hyperplasia.

The authors investigated the association of anthropometric measures with the presence and progression of components of benign prostatic hyperplasia (BPH) and a clinical outcome of BPH in a cohort of healthy, Caucasian men aged 40-79 years that was randomly selected from the Olmsted County, Minnesota, population beginning in 1990. Exclusionary criteria included prostate or bladder surgery, urethral surgery or stricture, or medical or other neurologic conditions that could affect normal urinary function. Height, weight, and waist and hip circumferences were measured. Components of BPH, including American Urological Association Symptom Index scores, peak urinary flow rate, and prostate volume, were assessed on a randomly selected subsample. Acute urinary retention was assessed through review of community medical records. There were few significant associations of anthropometric measures with the presence or progression of components of BPH or clinical outcome of BPH, and there were no instances where the point estimates for the BPH components suggested a dose-response effect. The authors conclude that anthropometric measures are not significantly associated with the presence or progression of BPH as measured by American Urological Association Symptom Index scores, peak urinary flow rate, prostate volume, or acute urinary retention. These data provide no evidence of a consistent significant relation between anthropometric measures and BPH.

Adult↗

PubMed2006

Polymorphisms in genes involved in sex hormone metabolism may increase risk of benign prostatic hyperplasia.

BACKGROUND: This study investigates associations between polymorphisms in genes involved in sex hormone metabolism and measures of benign prostatic hyperplasia (BPH). METHODS: Community-dwelling Caucasian men (n=510, median age 60 years in 2000) from the Olmsted County, MN, participated in a longitudinal study of BPH. From 1990 through 2000, urologic measures of BPH were assessed biennially from lower urinary tract symptom severity, peak flow rates, prostate volume, serum prostate specific antigen (PSA) level, acute urinary retention, and treatment for BPH. Men were genotyped for polymorphisms in genes involved in sex hormone metabolism. RESULTS: With the wildtype genotype as reference, men with HSD3B1 (c.1100 A/C) heterozygous genotype (hazard ratio (HR)=0.7, 95% confidence intervals (CI)=0.6, 0.9) were at decreased risk of an enlarged prostate and men with CYP19 (TTTA)(n) genotype homozygous for >or=175 TTTA repeats (HR=1.5, 95% CI=1.1, 2.1), and CYP19 (c.1531 C/T) homozygous T variant (HR=1.6, 95% CI=1.1, 2.2) were at increased risk of an enlarged prostate. The homozygous A variant of the PSA gene (g.-252 G/A), was associated with treatment for BPH (HR=2.3, 95% CI=1.2, 4.4). In multivariate analyses, the homozygous variant genotypes of AKR1C3 (c.15 G/A and c.90 G/A) were associated with a decreased risk of an enlarged prostate (HR=0.56, 95% CI=0.35, 0.90 and HR=0.57, 95% CI=0.33, 0.98). CONCLUSIONS: Polymorphisms in HSD3B1, CYP19, AKR1C3 genes may be associated with an enlarged prostate in older men. These data provide insights into genes that should be examined further for their potential role in the pathogenesis of BPH.

3-Hydroxysteroid Dehydrogenases↗

PubMed2006

Correlations between longitudinal changes in transitional zone volume and measures of benign prostatic hyperplasia in a population-based cohort.

OBJECTIVE: To determine whether measures of transitional zone volume (TZV) are more strongly associated than total prostate volume with longitudinal urologic outcomes. METHODS: In 1990, 2,115 randomly selected Caucasian men from Olmsted County, Minnesota (USA) completed validated questionnaires during a home visit. A 25% subsample underwent clinical evaluation that included transrectal ultrasonography, assessment of serum prostate-specific antigen levels, and maximum urinary flow rates. Examinations and questionnaires were repeated biennially through 2004. TZV measures were taken at the fifth through eighth visits. Men with at least one TZV measurement were included in this study (n=336). RESULTS: Changes in TZV correlated weakly with changes in peak urinary flow rate and urinary symptoms. After accounting for age and change in total prostate volume, change in TZV added no information to models that predict changes in urinary symptoms and peak urinary flow rates. Men who experienced the most rapid annual changes in TZV were not more likely to experience more rapid changes in urinary symptoms or maximum flow rate. CONCLUSION: Tracking changes in TZV over time may be unlikely to provide a good surrogate measure for the development of benign prostatic hyperplasia.

Cohort Studies↗

PubMed2006

Diabetes and benign prostatic hyperplasia progression in Olmsted County, Minnesota.

OBJECTIVES: To examine the association of diabetes and progression of benign prostatic hyperplasia in a prospective population-based sample of residents of Olmsted County, Minnesota, with serial surrogate measures of benign prostatic hyperplasia. METHODS: A cohort of 2115 white men aged 40 to 79 years was randomly selected from an enumeration of the 1990 Olmsted County, Minnesota population (55% participation rate). Participants completed a previously validated baseline questionnaire that assessed lower urinary tract symptom severity from questions similar to the American Urological Association Symptom Index. The questionnaire also asked whether they had ever been diagnosed by a physician as having diabetes. Participants also voided into a portable urometer to measure the peak urinary flow rate. A 25% random subsample underwent transrectal ultrasonography to determine the prostate volume, and the prostate-specific antigen level was determined. Dynamic follow-up was performed biennially for 12 years with the measures repeated at each visit. RESULTS: Of the 2115 men 111 had diabetes at baseline. The men with diabetes had a significantly greater median annual percentage change in the American Urological Association Symptom Index (0.40 versus 0.15, P = 0.04) and a trend toward a greater median annual percentage of change in the peak urinary flow rate (-4.7% versus -2.9%, P = 0.06) compared with those without diabetes. However, no significant difference was found in the annual percentage of change in the prostate volume or serum prostate-specific antigen level. CONCLUSIONS: The results of this study suggest that the presence of diabetes may be more closely associated with the dynamic components of lower urinary tract function than with benign prostatic hyperplasia progression, per se.

Adult↗

PubMed2006

Growth factor, cytokine, and vitamin D receptor polymorphisms and risk of benign prostatic hyperplasia in a community-based cohort of men.

OBJECTIVES: To investigate the associations between benign prostatic hyperplasia (BPH) and polymorphisms in genes that encode growth factors, cytokines, and vitamin D and their receptors. METHODS: A total of 510 white men (median age 60 years) randomly selected from the Olmsted County, Minnesota community participated in a study of BPH from 1990 to 2000. Biennial measurements were made to assess the International Prostate Symptom Score, peak urinary flow rate, and prostate volume. Genotyping of genes that encode transforming growth factor, interleukin-10, tumor necrosis factor, and vitamin D receptor, among others, was performed. RESULTS: The CC genotype of the transforming growth factor-beta 1 gene was inversely associated with treatment for BPH (hazard ratio [HR] 0.38, 95% confidence interval [CI] 0.15 to 0.98). The presence of at least one allele with 17 or more CA repeats of the epidermal growth factor receptor gene was positively associated with an International Prostate Symptom Score greater than 7 (HR 1.32, 95% CI 1.01 to 1.73). The AA genotype of tumor necrosis factor-alpha was inversely associated with peak urinary flow rate (HR 0.33, 95% CI 0.12 to 0.90). For the vitamin D receptor gene, positive associations were found between prostate volume and the CC genotype of the T_C (Taq 1) polymorphism (HR 1.39, 95% CI 1.0 to 1.92) and the AA genotype of the G_A (Bsm 1) polymorphism (HR 1.36, 95% CI 1.06 to 1.74). CONCLUSIONS: These findings suggest that transforming growth factor-beta 1, tumor necrosis factor-alpha, epidermal growth factor receptor, and vitamin D receptor polymorphisms may be involved in the pathogenesis of BPH.

Adult↗

PubMed2006

Tracking of longitudinal changes in measures of benign prostatic hyperplasia in a population based cohort.

PURPOSE: We characterized how longitudinal changes in PSA, prostate size, maximum urinary flow rates and lower urinary tract symptoms track together over time. MATERIALS AND METHODS: In 1990, 2,115 white men, randomly selected from the Olmsted County, Minnesota population, completed validated questionnaires during a home visit by a study assistant. A 25% random subsample underwent clinical evaluation including transrectal ultrasonography, serum PSA and assessment of maximum urinary flow rates. Examinations and questionnaires were repeated biennially through 2002. Longitudinal changes in these measurements were estimated with 2-stage models. Annualized changes were correlated and also dichotomized at various percentiles and examined in age adjusted logistic regression models predicting symptom increases in the upper 80th percentile. RESULTS: Correlations between changes in prostate volume, PSA levels, maximum flow rates and urinary symptoms were modest (age adjusted Spearman correlation coefficients: volume and symptoms 0.08, p = 0.06; PSA and symptoms 0.06, p = 0.20; maximum flow rate and symptoms -0.08, p = 0.05). However, PSA and prostate volume annual increases in the upper 80th percentile were each associated with an approximately 2-fold increased risk of symptom changes in the upper 80th percentile. As PSA and prostate volume changes increased from the 50th to the 90th percentiles, the odds of having symptoms in the upper 80th percentile also increased. CONCLUSIONS: While overall correlations among changes in each of these variables were modest, men with more rapid annual increases in PSA levels and prostate volumes were also likely to have more rapid increases in urinary symptoms.

Adult↗

PubMed2005

Polymorphisms in the 5alpha reductase type 2 gene and urologic measures of BPH.

BACKGROUND: The objective of the study was to examine associations between SRD5A2 polymorphisms and measures of benign prostatic hyperplasia (BPH). METHODS: Participants were 510 Caucasian men (median age 60 years), randomly selected from the Olmsted County, MN community to participate in a longitudinal study of BPH. From 1990 through 2000, biennial measurements of lower urinary tract symptom severity (assessed from the American Urological Association Symptom Index, AUASI), peak urinary flow rates (Qmax), and prostate volume were made. Genotyping of SRD5A2 V89L, A49T, and TA repeat polymorphisms were performed. RESULTS: Compared with the VV genotype, the LL genotype was associated with an enlarged prostate (Hazard ratio (HR)=1.62, 95% confidence interval (CI)=1.06, 2.43) but not with AUASI, Qmax, or PSA. The A49T and TA repeat polymorphisms were not associated with BPH. When the LL/VL, AT/TT, and TA0/TA0 genotypes were considered high risk, the number of high risk genotypes increased with increasing prostate volume (32.3, 30.7, 34.1, and 38.7, respectively, P for trend=0.04). CONCLUSIONS: These findings do not demonstrate consistent associations between SRD5A2 genotypes and BPH. However, they suggest that the associations of V89L polymorphisms and prostate volume should be investigated further.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗

PubMed2005

Association between smoking and erectile dysfunction: a population-based study.

The association between smoking and erectile dysfunction was evaluated in a cohort of 2,115 Caucasian men, aged 40-79 years, randomly selected from Olmsted County, Minnesota. Smoking status was assessed by questionnaire; during the fourth biennial examination, erectile dysfunction was assessed with the Brief Male Sexual Function Inventory. Of the 1,329 men with a regular sexual partner, 173 were current smokers, 836 had previously smoked, and 203 reported erectile dysfunction. Compared with former and never smokers, current smokers in their forties had the greatest relative odds of erectile dysfunction, 2.74 (95% confidence interval (CI): 0.44, 16.89), compared with 1.38 (95% CI: 0.51, 3.74), 1.70 (95% CI: 0.82, 3.51), and 0.77 (95% CI: 0.27, 2.21) for men in their fifties, sixties, and seventies, respectively. Compared with men who never smoked, men who smoked at some time had a greater likelihood of erectile dysfunction (age-adjusted odds ratio = 1.42, 95% CI: 1.00, 2.02), and there was a dose response. Although the causal pathway underlying this association is not clear, this study contributes to the growing literature describing an association between smoking and erectile dysfunction.

Adult↗

PubMed2005

Limitations of using outcomes in the placebo arm of a clinical trial of benign prostatic hyperplasia to quantify those in the community.

OBJECTIVES: To quantify potential biases that may occur when placebo arms of clinical trials are used to characterize the natural history of disease and to compare incidence rates of benign prostatic hyperplasia (BPH) outcomes in community-dwelling men with outcomes in the placebo arm of a clinical trial of BPH. SUBJECTS AND METHODS: White men aged 50 years or older at baseline were selected randomly from the Olmsted County, Minnesota, community in 1990 and were monitored biennially through 1996 for urologic outcomes. Symptom progression, acute urinary retention, and minimally Invasive or surgical treatment of BPH were assessed from a validated questionnaire and a review of community medical records. Findings from the Olmsted County Study (N=1193) and a selected subcohort (n=238) were compared with those from the placebo arm of the Medical Therapy of Prostatic Symptoms trial (N=737). RESULTS: During more than 5088 person-years of follow-up (mean, 4.9 years) In the Olmsted County Study, Incidence rates per 1000 person-years were 8.5 (95% confidence Interval [CI], 6.4-11.2) for acute urinary retention, 97.1 (95% CI, 88.7-106.0) for symptom progression, 6.6 (95% CI, 4.8-9.0) for surgery or minimally invasive treatment, and 105.1 (95% CI, 96.4-114.4) for any outcomes for all men. For those meeting trial Inclusion criteria (selected subcohort, n=238), Incidence rates were 18.3, 86.5, 16.8, and 109.4, respectively. By comparison, Incidence rates per 1000 person-years for the placebo arm of the Medical Therapy of Prostatic Symptoms clinical trial for BPH (mean follow-up, 4.5 years) were 6 for acute urinary retention, 36 for symptom progression, and 45 for any outcome, but the estimate of 13 for surgery or minimally invasive treatment was higher than for men in the Olmsted County Study. CONCLUSIONS: Compared with community-dwelling men, men in the placebo arm of this clinical trial of BPH treatments had a substantially lower risk of BPH-related outcomes. Extrapolation of findings from the placebo arm of clinical trials to describe the natural history of disease in community-dwelling men should be done with caution and appropriate recognition of limitations.

Adult↗

PubMed2005

A population based study of incidence and treatment of benign prostatic hyperplasia among residents of Olmsted County, Minnesota: 1987 to 1997.

PURPOSE: The treatment of benign prostatic hyperplasia (BPH), a common problem faced by aging men, has changed dramatically during the last decade. While BPH has long been considered a surgical condition, the advent of less invasive therapies makes the evaluation of the use of these various treatments important. Thus, this population based study was undertaken to describe the incidence and treatment for BPH from 1987 to 1997 among residents of Olmsted County, Minnesota. MATERIALS AND METHODS: We identified all Olmsted County men with a new diagnosis of BPH from 1987 to 1997 through the Medical and Surgical Indices made available through the Rochester Epidemiology Project. Overall year and age specific incidence rates were calculated for diagnosed BPH and by treatment type (surgical, minimally invasive, pharmacological, watchful waiting) assuming all men of the Olmsted County population to be at risk. Temporal changes in incidence were analyzed by Poisson regression. RESULTS: From 1987 to 1997, 2,330 cases of BPH were identified representing an age adjusted, corrected incidence for BPH among male residents of Olmsted County of 854.7 per 100,000 men. While the incidence of BPH increased from 1987 to 1992, coinciding with the introduction of serum prostate specific antigen testing, and subsequently decreased through 1997, the overall incidence of BPH decreased during the 10-year period for the entire cohort (p =0.002). Although the incidence of watchful waiting appeared to increase in the mid 1990s, significant decreases in age adjusted incidence were observed for the period overall (p <0.001). Significant decreases in surgical treatments were observed (p <0.0001). In contrast, there were significant increases in the age adjusted rates of pharmacological treatments during the 10 years (p <0.0001). No significant differences in incidence patterns of treatment type over time were observed by age group. CONCLUSIONS: The introduction of serum prostate specific antigen testing as a screening tool for prostate cancer along with the advent of less invasive alternatives, including pharmacological therapy, have had a significant impact on the incidence of diagnosed BPH in the last decade.

Adrenergic alpha-Antagonists↗

PubMed2005

Cross-sectional associations of urogenital pain and sexual function in a community based cohort of older men: olmsted county, Minnesota.

PURPOSE: Increasing age has been associated with decreasing male sexual function. We evaluated the association of urogenital pain with sexual function in a community based cohort of older men. MATERIALS AND METHODS: In 2000, 1,764 white men with a median age of 60 years residing in Olmsted County, Minnesota completed a questionnaire that included questions from the National Institutes of Health Chronic Prostatitis Symptom Index to evaluate urogenital pain that is ejaculatory, penile, perineal, suprapubic and testicular pain, and pain on urination. Questions from the Brief Male Sexual Function Inventory were used to evaluate 5 domains of sexual function, including sexual drive, erectile function, ejaculatory function, assessment of sexual problems and overall sexual satisfaction. RESULTS: Of 1,248 men who reported a regular sexual partner there were significant associations of testicular pain with impaired sexual drive (OR 2.5, 95% CI 1.4 to 4.4) and sexual satisfaction (OR 1.8, 95% CI 1.1 to 3.2) after adjustment for age. A pain score of 4 or greater was associated with impaired sexual drive (OR 1.6, 95% CI 1.0 to 2.6) and impaired ejaculatory function (OR 1.7, 95% CI 1.0 to 2.7). Men with impaired mental health and penile pain were less likely to report impaired sexual drive (OR 0.4, 95% CI 0.04 to 3.2) than men without impaired mental health and penile pain (OR 5.2, 95% CI 1.3 to 20.8, interaction p = 0.03). CONCLUSIONS: Urogenital pain may be associated with impaired sexual function in older men. Furthermore, men with impaired mental health may be less likely to report pain associated impairment of sexual function, while the reverse may be true in the presence of comorbidity.

Adult↗

PubMed2005

Longitudinal changes in post-void residual and voided volume among community dwelling men.

PURPOSE: We describe the natural history of post-void residual (PVR) and voided volume (VV) in men. MATERIALS AND METHODS: A random sample of community dwelling men (529 men 40 to 79 years old) were followed with a sonographic PVR and VV every 2 years for up to 12 years (median 5 examinations). Men were censored at the time of treatment for a prostate condition. RESULTS: The median annual change (slope) for PVR was 2.2% (p=0.03) and for VV was -2.1% (p <0.0001). There was considerable variability in PVR slopes (25th percentile -11%, 75th percentile 18%). A rapid increase in PVR slope (greater than 80th percentile) was more likely in men with a baseline American Urological Association Symptom Index greater than 7 (age adjusted odds ratio [OR]1.6, 95% CI 1.0 to 2.5). There was less variability in VV slopes (25th percentile -8.0%, 75th percentile 3.1%). A rapid decrease in VV slope (less than 20th percentile) was more likely in men with baseline age 70 to 79 years than 40 to 49 years (OR 3.9, 95% CI 2.1 to 7.2) and in men with a baseline PVR greater than 50 ml (age adjusted OR 2.1, 95% CI 1.2 to 3.6). CONCLUSIONS: Although it is highly variable, there is progressive bladder dysfunction in community dwelling men as they age. In addition, signs and symptoms attributed to benign prostatic hyperplasia were modest predictors of the development of bladder dysfunction. A baseline increased PVR predicted a rapid decrease in VV, consistent with a bladder outlet obstruction contributing to the development of detrusor overactivity and decreased bladder compliance.

Adult↗

PubMed2005

Prevalence of conditions potentially associated with lower urinary tract symptoms in men.

OBJECTIVE: To estimate the frequency of conditions associated with lower urinary tract symptoms (LUTS, typically included when assessing benign prostatic hyperplasia, BPH), as other causes of LUTS should be excluded when diagnosing BPH, using data from the Olmsted County Study of Urinary Symptoms and Health Status among Men. SUBJECTS AND METHODS: During 1989-91, Caucasian men aged 40-79 years were randomly selected from the Olmsted County population. Before contact, eligibility was determined by reviewing the community medical records. Baseline exclusion criteria included comorbid pre-existing conditions or treatments, e.g. prostate, bladder or lower back surgery, bladder neck contracture or cancer, diabetes with lower extremity amputation, and neurological diseases, including Parkinson's disease, amyotrophic lateral sclerosis, multiple sclerosis, tabes dorsalis and stroke. Men with these conditions were excluded from the Olmsted County Study at baseline, because these conditions are potentially associated with LUTS. RESULTS: Of the 5100 randomly sampled men, 13.4% met at least one of the pre-existing exclusion criteria. Individually, the frequency of exclusions was 7.8% for prostate cancer or surgery, 4.8% for back surgery, 1.3% for bladder surgery and 1.4% for neurological conditions. All other conditions represented <1.0% of the study exclusions. Older men were more likely to meet at least one of the exclusion criteria, with men in their fifth to eighth decade having a total exclusion frequency of 1.4%, 5.4%, 8.5% and 32.8%, respectively. The most common reason for men in their fifth decade to be excluded was lower back surgery (0.9%), whereas the most common reason in the eighth was prostate surgery (21.8%). CONCLUSIONS: In men, conditions that may contribute to LUTS, other than BPH, are prevalent in the community and increase in frequency with age. It is important that other conditions associated with LUTS be excluded before a definitive diagnosis of BPH. Any oversight in this initial evaluation can potentially result in misclassification bias, misdiagnosis and incorrect treatment of patients.

Adult↗

PubMed2005

The association between benign prostatic hyperplasia and chronic kidney disease in community-dwelling men.

BACKGROUND: Benign prostatic hyperplasia (BPH) and chronic kidney disease are important public health problems in older men. Previous referral-based studies disagree on whether BPH is associated with chronic kidney disease. The objective of this study was to determine the community-based association between clinical measures of BPH and chronic kidney disease. METHODS: A community-based sample of 2115 white men (ages 40-79 years) was randomly selected from the Olmsted County, Minnesota population (55% participation rate) in 1990. A random subsample (N= 476) had a detailed clinical evaluation. This evaluation included a questionnaire with similar queries to the International Prostate Symptom Score (IPSS), peak urinary flow rates (uroflowmeter), postvoid residual urine volume (ultrasound), prostate volume (ultrasound), serum prostate specific antigen (PSA), and serum creatinine. RESULTS: After adjustment for age, hypertension, diabetes, leukocyte esterase positive (possible urinary tract infection), and smoking, chronic kidney disease [serum creatinine > or =133 micromol/L (1.5 mg/dL)] was associated with diminished peak urinary flow rate (<15 mL/sec) by an odds ratio (OR) = 2.96 (95% CI 1.30-7.01), moderate-severe lower urinary tract symptoms (IPSS >7) by an OR = 2.91 (95% CI 1.32-6.62), and chronic urinary retention (postvoid residual >100 mL) by an OR = 2.28 (95% CI 0.66-6.68). There was no association with a prostate volume >30 mL by an OR = 0.56 (95% CI 0.22-1.37) or PSA >1.4 ng/mL by an OR = 1.17 (95% CI 0.47-2.81). CONCLUSION: There was a cross-sectional association between signs and symptoms of bladder outlet obstruction and chronic kidney disease in community-dwelling men. Prostatic enlargement was not associated with chronic kidney disease.

Adult↗

PubMed2004

Serum sex hormones and measures of benign prostatic hyperplasia.

BACKGROUND: Despite biologic plausibility, the associations between sex hormones and measures of benign prostatic hyperplasia (BPH) have not been consistently reported. METHODS: 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. RESULTS: 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 CONCLUSIONS: While cross-sectional, these findings suggest a more complex relationship between sex steroids and prostate volume in older men than simple independent effects.

Adult↗

PubMed2004

Low agreement between previous physician diagnosed prostatitis and national institutes of health chronic prostatitis symptom index pain measures.

PURPOSE: We evaluate the agreement between self-reported physician diagnosed prostatitis and pain questions from the National Institutes of Health Chronic Prostatitis Symptom Index (CPSI). MATERIALS AND METHODS: A randomly selected cohort of white men 47 to 90 years old from Olmsted County, Minnesota completed a study questionnaire on a history of physician diagnosed prostatitis in the preceding 2 years, including the CPSI questions. The medical records were also reviewed for physician diagnosis of chronic prostatitis during the preceding 10 years. RESULTS: Of 1,543 men 27 (1.7%) reported a physician diagnosis of prostatitis in the preceding 2 years. There were strong associations between self-reported prostatitis and pain at the tip of the penis (OR 6.3, 95% CI 1.4, 28.5), ejaculatory (5.9, CI 1.3, 26.6) and testicular (3.6, 1.2, 10.8) pain. The chance corrected agreement between self-reported prostatitis and pain symptoms was low at 0.01 (pubic pain) to 0.07 (pain at the tip of the penis, ejaculatory pain and testicular pain). Agreement in positive responses was also low at 3.7% (perineal pain) to 8% (pain at the tip of the penis, ejaculatory pain and testicular pain). The predictive value of the modified total CPSI score for prostatitis was 0.67, which was better than chance (0.5). Associations based on medical record ascertainment of prostatitis during followup were weak, and the area under the curve was 0.57, which was no better than chance. CONCLUSIONS: These findings demonstrate low agreement between CPSI-like pain measures and self-reported physician diagnosed prostatitis. The stronger associations between pain symptoms and self-reported diagnosed prostatitis, and the moderate predictive ability of the modified total CPSI score measures for self-reported prostatitis compared to medical record ascertainment demonstrate the sensitivity of the CPSI to prevalent symptoms. Thus, the tool may be best used to evaluate the severity of current symptoms rather than to assess the presence or absence of prostatitis.

Adult↗

PubMed2004

Inverse association between prostate cancer and the use of calcium channel blockers.

Calcium channel blockers block calcium signal-mediated apoptosis. It is hypothesized that the use of these drugs may be associated with the development of cancer. This study investigated the association between daily use of calcium channel blockers and prostate cancer in a community-based cohort of men who participated in a longitudinal study of lower urinary tract symptoms. Study subjects were men ages 40 to 79 years by January 1, 1990, and were randomly selected from Olmsted County in Minnesota. At baseline, participants underwent an interview to determine all medications taken on a daily basis, including calcium channel blockers and to elicit a family history of prostate cancer. During follow-up, all men with a histological diagnosis of prostate cancer were identified through patient self-report and by a review of the complete medical record. Over 12,668 person years of follow-up, 15 (6.8%) of 220 calcium channel blocker users and 120 (10.5%) of 1142 nonusers developed prostate cancer (P = 0.09; odds ratio, 0.62; 95% confidence interval, 0.36-1.10). With adjustment for age and family history of prostate cancer, the risk (odds ratio, 95% confidence interval) of prostate cancer was 0.55 (0.31-0.97) in calcium channel blocker users compared with nonusers. In analyses stratified by family history of prostate cancer, the risk of prostate cancer was 0.45 (0.23-0.88) in men without a family history and 2.64 (0.82-8.47) in men with a family history of prostate cancer (P = 0.006). These findings suggest an association between prostate cancer and daily use of calcium channel blockers that varies by family history of prostate cancer.

Adult↗