NSAIDs Delay Benign Prostatic Hyperplasia Symptoms

September 4, 2006

Non-steroidal anti-inflammatory drugs – particularly aspirin – have been shown to delay onset of urinary symptoms of benign prostatic hyperplasia (BPH), according to a new study.

In this study, men taking NSAIDs had a 35% lower likelihood of developing urinary symptoms of BPH, according to Jennifer L St Sauver, PhD, an epidemiologist at the Mayo Clinic, and colleagues.

Dr Sauver and colleages reported their findings in the American Journal of Epidemiology, online edition, August 11, and MedPage Today summarized their findings on August 30.

The findings mark an unexpected side-benefit for men already taking a daily NSAID to prevent heart disease or arthritis, according to the researchers, who noted that the results do not provide enough support to recommend men take a daily NSAID for the purpose of staving off BPH symptoms.

Results showed that men taking a daily NSAID had a 50% reduced chance of decreased urinary flow, larger prostate volume and elevated Prostate-Specific Antigen (PSA). Moreover, the NSAID group required 20% less BPH treatment.

"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 non-aspirin and whether data for long-term or shorter-term NSAID users were examined," wrote Dr Sauver and colleagues, who concluded that the observed benefits of NSAIDs on BPH are consistent with previous reports for prostate cancer.

Clinical Trials

The trial followed 2,447 men in Minnesota over 12 years and included annual office examinations and medical questionnaires about urologic health. The researchers evaluated use of medications only at the initial visit and the fifth two-year visit.

On the first visit, 33% of participants reported using a daily NSAID, and the majority of these (80%) took aspirin.

After adjusting results for participants’ age, NSAID use was inversely associated with:

• onset of moderate/severe urinary symptoms
• low maximum flow rate
• increased prostate volume
• elevated prostate-specific antigen level.

Further adjustment for hypertension, diabetes, coronary heart disease and baseline physician visits strengthened these associations, and varying definitions of BPH did not affect the association for men taking daily NSAID medications for:

• decreased risk of developing any urologic endpoint
• reduced risk of developing at least two urologic endpoints
• decreased risk of developing at least three urologic endpoints.

Based on scant information collected about dosing, using higher-dose aspirin (>85 mg/day) had somewhat better (but generally statistically significant) results than low-dose aspirin (≤85 mg/day).

Also, older men tended to have stronger associations between NSAID use and reduced risk for each outcome, compared with younger men, perhaps because of longer exposure to NSAID use.

Sources:
NSAIDs Retard BPH Symptoms, MedPage Today, August 30, 2006.
Protective Association between Nonsteroidal Antiinflammatory Drug Use and Measures of Benign Prostatic Hyperplasia. Jennifer L St Sauver, et al, American Journal of Epidemiology, published online on August 11, 2006.

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