NSAIDs Retard BPH Symptoms

ROCHESTER, Minn., Aug. 30 -- Symptomatic delay of benign prostatic hyperplasia may be a serendipitous benefit of the daily use of a nonsteroidal anti-inflammatory drug, according to investigators here.

Men who took any type of NSAID, especially aspirin, were 35% less likely to develop urinary symptoms of BPH, epidemiologist Jennifer L. St. Sauver, Ph.D., of the Mayo Clinic, and colleagues, reported online in the American Journal of Epidemiology.

The BPH benefit was an unintended, benefit for men who already take a daily NSAID for heart disease prevention or arthritis, they said. They cautioned that men should not start taking a daily NSAID on the basis of the population-based cohort study, which was sponsored by the NIH.

Daily NSAID users were half as likely to have decreased urinary flow, large prostate volume, and an elevated PSA, the investigators said. As a group, the NSAID-users needed 20% less treatment for BPH.

"The decreased risk of developing these urologic outcomes was consistent whether the endpoints were examined singly or were combined, and it remained consistent regardless of whether the NSAID used was aspirin or nonaspirin and whether data for long-term or shorter-term NSAID users were examined," the investigators wrote.

The investigators concluded that the NSAID benefit for benign prostatic hyperplasia is consistent with what has previously been reported for prostate cancer.

The study followed nearly 2,500 men in Minnesota for 12 years with office examinations and questionnaires on urological health every other year. Medication use was evaluated at the initial and fifth biennial visits only. Overall, 33% of the men reported using daily NSAID medication at the first visit, the majority of whom took aspirin (80%).

After adjusting for age, NSAID use was significantly associated with reduced likelihood of:

• Onset of moderate to severe urinary symptoms during the study (hazard ratio 0.73, 95% confidence interval 0.64 to 0.82),
• Onset of low maximum flow rate (HR 0.51, 95% CI 0.43 to 0.61),
• Increased prostate volume (HR 0.53, 95% CI 0.41 to 0.68),
• Elevated serum prostate-specific antigen level (HR 0.52, 95% CI 0.40 to 0.68), and
• Treatment for benign prostatic hyperplasia (HR 0.79, 95% CI 0.65 to 0.95).

These associations were strengthened by further adjustment for baseline physician visits, diabetes, hypertension, and coronary heart disease.

Regardless of how strictly benign prostatic hyperplasia was defined, the association was consistent for men who reported taking daily NSAID medication:

• A decreased risk of developing any urologic endpoint (HR 0.71, 95% CI 0.63 to 0.79),
• A reduced risk of developing at least two urologic endpoints (HR 0.69, 95% CI 0.59 to 0.80), and
• A decreased risk of developing at least three urologic endpoints (HR 0.60, 95% CI 0.47 to 0.76).

Although little dosing information was collected, using a higher dose aspirin (>85 mg/day) was somewhat better than low dose aspirin (?85 mg/day), for which the results were generally not statistically significant. Long- and short-term use of a daily NSAID, on the basis of whether men reported use at only the initial visit or both time points, were generally consistent.

Older men, who may have been exposed to a longer duration of NSAID use, tended to have a stronger association between NSAID use and lowered risk for each of the outcomes examined in the study compared with younger men.

Suggested mechanisms from other studies include decreased prostaglandin synthesis, inhibition of the prostate androgen receptors, and increased apoptosis in prostatic cells.

"If inflammation plays an important role in the development or worsening of [benign prostatic hyperplasia], anti-inflammatory agents may offer useful adjunct medical therapies for treatment of this syndrome," the investigators wrote.