Do prostate size and urinary flow rates predict health care-seeking behavior for urinary symptoms in men?

ABSTRACT

OBJECTIVES: To estimate the association between health care-seeking behavior for urinary dysfunction and clinical, physiologic, and anatomic measures of disease. METHODS: A randomly selected sample (n = 475) of men aged 40 to 79 years from Olmsted County, Minnesota, was administered a previously validated questionnaire that assessed the frequency of and bother associated with urinary symptoms and health care-seeking behavior in the past year. Peak urinary flow rates were measured with a standard urometer and prostatic volume was determined by transrectal ultrasound. RESULTS: Overall, 21 of the 475 men (4%) had seen a doctor in the past year for urinary symptoms. Men with moderate to severe symptoms (American Urological Association [AUA] Symptom Scores > 7) were 3.4 times as likely (95% confidence interval [CI] = 1.4, 8.3) to have sought medical care in the past year as men with none to mild symptoms. Men with enlarged prostates (> 40 mL) were 3.9 times as likely to have sought health care (95% CI = 1.6, 9.6), whereas men with depressed peak urine flow rates (< 10 mL/s) were only slightly more likely to have sought health care for urinary symptoms (odds ratio = 2.1, 95% CI = 0.7, 6.5). Overall, 76% of men who had sought medical care had prostatic enlargement, depressed peak urine flow rates, or moderate-severe symptoms (sensitivity). In contrast, only 55% of men who did not seek health care for urinary symptoms in the past year had mild symptoms, normal prostatic volume, and normal peak urine flow rates (specificity). CONCLUSIONS: These data suggest that clinical, physiologic, and anatomic measures of prostatism do not adequately distinguish the men who seek medical care for their urinary symptoms from those who do not. There remain some factor(s) that apparently lead some men with minor disease to seek care and that prevent men with measurable disease from seeking care.