title: Radical prostatectomy improves and prevents age dependent progression of lower urinary tract symptoms.
abstract: OBJECTIVE
  The prevalence of lower urinary tract symptoms increases with age and impairs quality of life. Radical prostatectomy has been shown to relieve lower urinary tract symptoms at short-term followup but the long-term effect of radical prostatectomy on lower urinary tract symptoms is unclear.
  
  
  METHODS
  We performed a prospective cohort study of 1,788 men undergoing radical prostatectomy. The progression of scores from the self-administered AUASS (American Urological Association symptom score) preoperatively, and at 3, 6, 12, 24, 48, 60, 84, 96 and 120 months was analyzed using models controlling for preoperative AUASS, age, prostate specific antigen, pathological Gleason score and stage, nerve sparing, race and marital status. This model was also applied to patients stratified by baseline clinically significant (AUASS greater than 7) and insignificant (AUASS 7 or less) lower urinary tract symptoms.
  
  
  RESULTS
  Men exhibited an immediate worsening of lower urinary tract symptoms that improved between 3 months and 2 years after radical prostatectomy. Overall the difference between mean AUASS at baseline and at 10 years was not statistically or clinically significant. Men with baseline clinically significant lower urinary tract symptoms experienced immediate improvements in lower urinary tract symptoms that lasted until 10 years after radical prostatectomy (13.5 vs 8.81, p <0.001). Men with baseline clinically insignificant lower urinary tract symptoms experienced a statistically significant but clinically insignificant increase in mean AUASS after 10 years (3.09 to 4.94, p <0.001). The percentage of men with clinically significant lower urinary tract symptoms decreased from baseline to 10 years after radical prostatectomy (p = 0.02).
  
  
  CONCLUSIONS
  Radical prostatectomy is the only treatment for prostate cancer shown to improve and prevent the development of lower urinary tract symptoms at long-term followup. This previously unrecognized long-term benefit argues in favor of the prostate as the primary contributor to male lower urinary tract symptoms.
authors: Department of Urology, New York University School of Medicine, New York, New York.
authors: Vinay
authors: V
authors: Prabhu
authors: Department of Population Health, New York University School of Medicine, New York, New York; Department of Medicine, New York University School of Medicine, New York, New York.
authors: Glen B
authors: GB
authors: Taksler
authors: Department of Urology, New York University School of Medicine, New York, New York.
authors: Ganesh
authors: G
authors: Sivarajan
authors: Department of Urology, New York University School of Medicine, New York, New York.
authors: Juliana
authors: J
authors: Laze
authors: Department of Urology, New York University School of Medicine, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York; New York University Cancer Institute, New York, New York; Veterans Affairs New York Harbor Healthcare System, New York, New York; Robert F. Wagner Graduate School of Public Service, New York, New York.
authors: Danil V
authors: DV
authors: Makarov
authors: Department of Urology, New York University School of Medicine, New York, New York; New York University Cancer Institute, New York, New York. Electronic address: Herbert.lepor@med.nyu.edu.
authors: Herbert
authors: H
authors: Lepor
mesh_terms: D000367:Age Factors; D018450:Disease Progression; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000503:physiopathology; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000601:surgery; D011788:Quality of Life; D013997:Time Factors
keywords: BPH; LUTS; PSA; RP; benign prostatic hyperplasia; lower urinary tract symptoms; prostate specific antigen; prostatectomy; prostatic neoplasms; quality of life; radical prostatectomy; treatment outcome
references: CA Cancer J Clin. 2011 Jul-Aug;61(4):212-36
references: 21685461
references: BJU Int. 2003 Sep;92(4):409-14
references: 12930430
references: N Engl J Med. 2012 Jul 19;367(3):248-57
references: 22808960
references: Urology. 1998 Mar;51(3):428-36
references: 9510348
references: Int J Impot Res. 2003 Aug;15(4):299-306
references: 12934061
references: Cancer. 2005 Feb 1;103(3):538-45
references: 15612083
references: Urology. 2004 Mar;63(3):487-91
references: 15028443
references: J Clin Oncol. 2010 Mar 1;28(7):1117-23
references: 20124165
references: Am J Manag Care. 2006 Apr;12(5 Suppl):S129-40
references: 16613527
references: Urology. 2013 Jan;81(1):61-5
references: 23127798
references: Urology. 2000 Jan;55(1):58-61
references: 10654895
references: Urology. 2009 Jul;74(1):34-8
references: 19428076
references: J Urol. 2004 Mar;171(3):1212-5
references: 14767304
references: Urology. 2006 Jul;68(1):142-7
references: 16777193
references: J Urol. 1993 Jul;150(1):85-9
references: 7685427
references: Eur Urol. 2014 Jan;65(1):52-7
references: 23957946
references: J Urol. 2011 May;185(5):1793-803
references: 21420124
references: J Urol. 2003 Jun;169(6):2147-52
references: 12771737
references: BJU Int. 2009 Apr;103 Suppl 3:4-11
references: 19302497
references: N Engl J Med. 2008 Mar 20;358(12):1250-61
references: 18354103
references: Curr Urol Rep. 2006 Jul;7(4):272-81
references: 16930498
references: Eur Urol. 2004 Nov;46(5):547-54
references: 15474261
references: N Engl J Med. 2013 Jan 31;368(5):436-45
references: 23363497
references: J Urol. 1995 Nov;154(5):1770-4
references: 7563343
references: World J Urol. 2011 Apr;29(2):171-8
references: 21221974
references: J Urol. 1992 Nov;148(5):1549-57; discussion 1564
references: 1279218
references: J Urol. 2002 Oct;168(4 Pt 1):1446-52
references: 12352415
references: BJU Int. 2011 Feb;107(4):585-90
references: 20804482
references: J Urol. 1999 Apr;161(4):1185-8
references: 10081866
references: J Urol. 2004 Mar;171(3):1216-9
references: 14767305