Daily NSAID use may protect against BPH, LUTS

February 1, 2007

Rochester, MN-Men who take non-steroidal anti-inflammatory drugs (NSAIDs) daily have a decreased risk for developing BPH and associated lower urinary tract symptoms, according to analyses of data collected in a longitudinal population-based cohort study of aging men.

The study by researchers from the Mayo Clinic, Rochester, MN, comprised 2,447 men participating in the Olmsted County Study of Urinary Symptoms and Health Status Among Men. Launched in 1990, that trial enrolled men between 40 and 79 years of age with no history of prostatectomy, prostate cancer, or other urologic conditions. Follow-up is ongoing, but NSAID use and BPH risk were analyzed using data collected at biennial visits through 2002.

Information on prescription and over-the-counter medication use was collected at baseline in all men, and urinary flow rate and lower urinary tract symptom severity were measured at all visits. In addition, 634 men underwent more de-tailed clinical exams and had baseline and follow-up data available on PSA and prostate volume.

"Currently, our findings do not justify a recommendation for men to begin taking NSAIDs to lower their risk of BPH. However, they suggest men who are already using these medications for some other medical condition may derive that effect as an additional potential benefit."

In the study, aspirin accounted for about 80% of daily NSAID use; about 7% of those men were taking low-dose aspirin (85 mg/day or less). When subgroup analyses were conducted examining the potential for risk reductions based on type of NSAID used, risks of developing moderate/ severe urinary symptoms, decreased urinary flow, an enlarged prostate, and need for BPH treatment also were significantly reduced in men taking NSAIDs other than aspirin (eg, ibuprofen, diclofenac, and naproxen), although the effects were not quite as strong as with aspirin use.

Among low-dose aspirin users, there was a significant benefit only for reducing the risk of developing moderate/severe urinary symptoms. Risks were decreased for the other endpoints, as well, although the effects were not statistically significant.

"The small number of men using low-dose aspirin may have limited our power to detect a statistically significant benefit. However, the positive trends observed are encouraging in suggesting that the prostate-related benefits of this class of medication can still be derived and with greater safety using a low NSAID dose," Dr. St. Sauver said.

An association between NSAID use and BPH has been examined in few prior studies. Those investigations examined rates of prevalent BPH (versus incident BPH), used nonspecific measures to establish BPH diagnosis, and lacked detailed information on medication use frequency, she noted.

"The population-based design of our study and its long follow-up are its main strengths. Enrolling generally healthy men from the community, rather than from a urology clinic population wherein prostate disease is already prevalent, and following our subjects for 12 years provides power to identify a significant association between BPH measures and NSAID use if they exist," she explained.