Photoselective vaporization of the prostate using the 120-W lithium triborate laser in enlarged prostates (>120 cc).

UNLABELLED: OBJECTIVE • To evaluate experience with high power LBO laser for large prostates PATIENTS AND METHODS: • Prospective database of 288 men treated with PVP from November 2006-2009 • 33 men identified to have transrectal ultrasound measured prostate size >120 cc • All but 9 men not in urinary retention or on anticoagulant medications • Average ASA Score 2.25 (range 1-4) with 11 having an ASA Score of 3 or more RESULTS: • Mean operating time and laser time 109 and 86 minutes respectively • IPSS, QoL and Qmax changes from baseline to 3 months for those not in retention were 24 to 8.6, 5.0 to 1.8 and 7.5 mL/s to 19.6 mL/s respectively • Post void residual in these men fell from a mean of 235 mL to 88 mL • Average fall in PSA was 38% for 22 men with paired PSA data • Post operative urinary retention in 4 men resolved. 2 late onset clot urinary retention CONCLUSION: • Early results demonstrate PVP to be safe and efficacious on early follow up in a high risk group of patients with significantly enlarged prostates, anticoagulation and urinary retention.

Serum sex hormones and the 20-year risk of lower urinary tract symptoms in community-dwelling older men.

OBJECTIVE: To evaluate serum sex steroid hormone concentrations and long-term risk of subsequent lower urinary tract symptoms (LUTS) in a cohort of community-dwelling older men. SUBJECTS AND METHODS: Between 1984 and 1987, serum sex hormone concentrations were measured in participants in the Rancho Bernardo Study, a prospective, community-based study. In 2006, the American Urological Association Symptom Index (AUA-SI) was mailed to surviving male participants. Logistic regression was used to examine associations of baseline hormone concentrations with AUA-SI. RESULTS: Among 158 surviving men with complete data and no history of prostate cancer, the mean (sd) age at serum sex steroid assessment was 58 (6.6) years with a mean (sd) follow-up of 20.3 (0.6) years. In age-adjusted logistic regression, there was a significant inverse association of testosterone : dihydrotestosterone (DHT) with LUTS (P = 0.05). Also, men with higher concentrations of bioavailable testosterone had a 56% decreased risk of LUTS compared with those with hypogonadal concentrations, although the association was not statistically significant (odds ratios 0.44, 95% confidence interval 0.14-1.40) or distributed evenly among quartiles. There were no significant associations of total testosterone, oestradiol (E(2)), testosterone : E(2), DHT, or dehydroepiandrosterone with LUTS or with any measured hormones and urinary bother. CONCLUSIONS: In this cohort, men with higher mid-life levels of testosterone : DHT and bioavailable testosterone had a decreased 20-year risk of LUTS. These data support other studies reporting inverse associations of serum testosterone with LUTS. Clinical trials of testosterone therapy should include LUTS and clinical benign prostatic hyperplasia as outcomes.

Relationship between lower urinary tract symptoms and serum levels of sex hormones in men with symptomatic benign prostatic hyperplasia.

OBJECTIVES: To investigate a possible association between the severity of lower urinary tract symptoms (LUTS) and the serum levels of sex hormones in men with symptomatic benign prostatic hyperplasia (BPH) that underwent surgery for severe benign prostatic obstruction. PATIENTS AND METHODS: In all, 127 selected men with symptomatic BPH attending our urology clinic were recruited. The clinical conditions of BPH were assessed by digital rectal examination, serum prostate-specific antigen (PSA) determination, International Prostate Symptom Score (IPSS), transrectal ultrasonography and maximum urinary flow rate (Q(max) ) value at uroflussimetry. Before surgery, we measured the serum concentrations of total testosterone (TT) and free testosterone (FT), oestradiol, prolactin, luteinizing hormone and follicle-stimulating hormone. We excluded men with endocrine diseases, those with prostate disease who were receiving antiandrogen therapy and those with psychological diseases. The relationships between the IPSS score and serum sex hormone levels were determined. RESULTS: The final study population consisted of 122 men (mean age of 70.66 years), as five were excluded (three due to incomplete evaluation and two who were diagnosed with prostate cancer). On statistical analysis, the total IPSS was significantly associated with age (r= 0.405, P < 0.001) and TT (r= 0.298, P= 0.020) but not with FT or the serum levels of the other sex hormones. The serum levels of testosterone and IPSS did not correlate with prostate volume and Q(max) . PSA level and age correlated with prostate volume (r= 0.394, P < 0.001; r = 0.374, P < 0.001, respectively). We distinguished two subgroups of patients: the first group of 40 men with an IPSS of <19 and the second group of 82 with an IPSS of >19, and we evaluated the median levels of TT in each group. There was an increased risk of LUTS in men with a greater serum concentration of TT (P= 0.042), although the mean TT level was in the normal range. CONCLUSIONS: In the present study, the severity of LUTS was associated with age and serum levels of TT but only age correlated with the measures of BPH, especially prostate volume. The potential effects of testosterone on LUTS may well be indirect. Additional large studies are needed to confirm these preliminary results.

Invited commentary: Lower urinary tract symptoms and inflammation--weighing the evidence.

Lower urinary tract symptoms (LUTS) are a common condition, particularly among older men. The etiology of these symptoms is often obscure and not always clearly related to prostatic enlargement or benign prostatic hyperplasia. St. Sauver et al. (Am J Epidemiol. 2009;169(11):1281-1290) hypothesized that systemic inflammation may be associated with LUTS and benign prostatic hyperplasia. Using a well-defined cohort, they found that, in general, inflammation was not related to LUTS or to benign prostatic hyperplasia progression. However, men with the highest amount of systemic inflammation, as measured by C-reactive protein levels, were at increased risk of a rapid change in irritative voiding symptoms and decreased urinary flow but not obstructive voiding symptoms or prostate size. To what degree systemic inflammation relates to inflammation within the urinary system and specifically the bladder and/or prostate is unclear. Furthermore, to what degree inflammation within the urinary system contributes to LUTS is unclear. Given that clinical trials of antiinflammatory drugs for LUTS have been largely unsuccessful, the role of inflammation as a contributor to LUTS remains an interesting hypothesis that requires further study.

Associations between C-reactive protein and benign prostatic hyperplasia/lower urinary tract symptom outcomes in a population-based cohort.

Inflammation may play a role in the development of benign prostatic hyperplasia and/or lower urinary tract symptoms (LUTS). Higher levels of C-reactive protein (CRP) may therefore be associated with the development of these outcomes. The authors examined the association of CRP levels measured in 1996 with rapid increases in prostate volume, prostate-specific antigen levels, and LUTS as well as rapid decreases in peak flow rates (through 2005) in a population-based cohort of men residing in Olmsted County, Minnesota. Men with CRP levels of > or =3.0 mg/L were more likely to have rapid increases in irritative LUTS (odds ratio (OR) = 2.14, 95% confidence interval (CI): 1.18, 3.85) and rapid decreases in peak flow rates (OR = 2.54, 95% CI: 1.09, 5.92) compared with men with CRP levels of <3.0 mg/L. CRP levels were not significantly associated with rapid increases in prostate volume, obstructive LUTS, or prostate-specific antigen levels. Associations were attenuated after adjusting for age, body mass index, hypertension, and smoking history (irritative LUTS: OR = 2.00, 95% CI: 1.04, 3.82; peak flow rate: OR = 2.45, 95% CI: 0.73, 8.25). These results suggest that rapid increases in irritative LUTS and rapid decreases in peak flow rates may be due to inflammatory processes.

Screening by lower urinary tract symptoms vs asymptomatic prostate-specific antigen levels leading to radical prostatectomy in Danish men: tumour characteristics and treatment outcome.

OBJECTIVE: To compare the tumour characteristics and treatment outcome in men undergoing radical prostatectomy (RP) for prostate cancer diagnosed with or with no lower urinary tract symptoms (LUTS). PATIENTS AND METHODS: In Denmark, prostate-specific antigen (PSA) testing is recommended only in men with a family history of prostate cancer, or those with LUTS that could be caused by prostate cancer. However, increasingly many men undergoing RP are asymptomatic and are diagnosed as a result of unsystematic PSA screening. Data were collected prospectively from The Aarhus PC-project, comprising 585 consecutive Danish men treated with RP between 1997 and 2008 at Aarhus University Hospital; of these, 47 had a family history of prostate cancer and were therefore excluded. RESULTS: In all, 188 (35%) patients stated being asymptomatic at the diagnosis of cancer, while LUTS led to the diagnosis in 350 (65%). Except for tumour grade after RP there were no significant differences between these subpopulations in tumour characteristics and treatment outcome. Unexpectedly, the Gleason score of the RP specimen was a statistically significant prognostic indicator (P = 0.002) in favour of symptomatic patients. CONCLUSION: This study showed no association between LUTS and tumour characteristics or treatment outcome between symptomatic and asymptomatic patients undergoing RP. The Gleason score at RP and thereby the long-term prognosis in asymptomatic patients seems to be worse than in patients with LUTS.

Associations of lower urinary tract symptoms with prostate-specific antigen levels, and screen-detected localized and advanced prostate cancer: a case-control study nested within the UK population-based ProtecT (Prostate testing for cancer and Treatment) study.

OBJECTIVE: To determine associations of lower urinary tract symptoms (LUTS) with prostate-specific antigen (PSA) levels and screen-detected localized and advanced prostate cancer. SUBJECTS AND METHODS: A case-control study nested within the UK population-based ProtecT (Prostate testing for cancer and Treatment) study. Men aged 50-69 years were invited for PSA testing and those with a PSA level of >or=3.0 ng/mL were invited for biopsy. We determined whether LUTS were associated with a PSA level of >or=3.0 ng/mL and prostate cancer using logistic regression models adjusted for age, family history of prostate cancer and PSA level as appropriate. Areas under receiver operating characteristic curves (AUC) were compared between models with and without symptoms. RESULTS: In all, 65 871 men had a PSA test: 7251 had a PSA level of >or=3.0 ng/mL including 2467 subsequently diagnosed with prostate cancer (2119 localized, 348 advanced). LUTS were positively associated with a PSA level of >or=3.0 ng/mL: odds ratios (ORs) were 1.18 (95% confidence interval, CI 1.01-1.38), 1.69 (95% CI 1.32-2.16), and 1.60 (95% CI 1.33-1.93) for daytime urination frequency (hourly vs less frequent), urgency and hesitancy (most/all the time vs never), respectively. LUTS among men with a PSA level of >or=3 ng/mL were negatively associated with prostate cancer: ORs were 0.44 (95% CI 0.22-0.83), 0.74 (95% CI 0.63-0.87), and 0.83 (95% CI 0.73-0.94) for nocturia (4+ vs 0), leakage and hesitancy (occasionally/sometimes vs never), respectively. LUTS improved the prediction of a PSA level of >or=3.0 ng/mL (AUC 0.635 vs 0.606, P < 0.001) and prostate cancer (AUC 0.661 vs 0.638; P < 0.001). CONCLUSIONS: A history of LUTS before PSA testing marginally improves the prediction of an individual's risk for prostate cancer; men with a PSA level of >or=3 ng/mL and LUTS were more likely to be diagnosed with benign disease than prostate cancer.

The association of urinary cadmium with sex steroid hormone concentrations in a general population sample of US adult men.

BACKGROUND: Studies investigating the association of cadmium and sex steroid hormones in men have been inconsistent, but previous studies were relatively small. METHODS: In a nationally representative sample of 1,262 men participating in the morning examination session of phase I (1998-1991) of the third National Health and Nutrition Examination Survey, creatinine corrected urinary cadmium and serum concentrations of sex steroid hormones were measured following a standardized protocol. RESULTS: After adjustment for age and race-ethnicity, higher cadmium levels were associated with higher levels of total testosterone, total estradiol, sex hormone-binding globulin, estimated free testosterone, and estimated free estradiol (each p-trend < 0.05). After additionally adjusting for smoking status and serum cotinine, none of the hormones maintained an association with urinary cadmium (each p-trend > 0.05). CONCLUSION: Urinary cadmium levels were not associated with sex steroid hormone concentrations in a large nationally representative sample of US men.

The relationship between lower urinary tract symptoms/benign prostatic hyperplasia and the number of components of metabolic syndrome.

OBJECTIVE: To investigate the relationship between lower urinary tract symptoms (LUTS)/benign prostate hyperplasia (BPH) and a number of components of metabolic syndrome (MetS). METHODS: A total of 1224 male police officers aged 50-59 years who had participated in a health examination were included. LUTS/BPH were assessed by prostate-specific antigen, international prostate symptom score (IPSS), total prostate volume (TPV), maximum urinary flow rate (Qmax), and postvoid residual (PVR) urine volume. Testosterone levels were also examined. MetS was defined using National Cholesterol Education Program-Adult Treatment Panel III guidelines. The subjects were classified into 4 groups according to the number of exhibited MetS components (0, 1-2, 3, and 4-5). We used the Mantel-Haenszel extension test and logistic regression analyses. RESULTS: MetS was diagnosed in 29.0% of the patients. The BPH ratio (IPSS >7, TPV ≥30 mL, and/or Qmax <15 mL/sec), TPV ≥30 mL, and PVR ≥50 mL significantly increased with an increasing number of metabolic abnormalities. The odds ratio (OR) in relation to a TPV ≥30 mL and a PVR ≥50 mL significantly rose as the number of positive MetS components increased after adjusting for age and testosterone. Additionally, the ORs (adjusting for age and testosterone) in relation to BPH also increased as the number of positive MetS components increased, with a suggestive threshold effect associated with 4-5 positive components (BPH: IPSS >7 + TPV ≥30 mL; 4 and 5 components, 3.496, 1.805-6.769, P = .001; BPH: IPSS >7 + TPV ≥30 mL + Qmax <15 mL/sec; 4 and 5 components, 5.458, 1.777-16.764, P = .002). CONCLUSION: According to our results, the cases of LUTS/BPH were positively associated with the number of MetS components.

Serum C-reactive protein levels are associated with residual urgency symptoms in patients with benign prostatic hyperplasia after medical treatment.

OBJECTIVE: Urinary urgency is a common and bothersome symptom in patients with benign prostatic hyperplasia (BPH); this symptom may persist even after medical treatment. Chronic inflammation has been reported to be associated with the pathogenesis of BPH and lower urinary tract symptoms (LUTS). We investigate the association between serum C-reactive protein (CRP) level and residual urgency symptoms in BPH patients after medical treatment. METHODS: Two-hundred-five men undergoing stable medical treatment for BPH, defined as a total prostate volume ≥40 mL, were enrolled. Patients with acute infection or those taking nonsteroid antiinflammatory drugs or aspirin were excluded. Uroflowmetry, postvoid residual volume, transrectal ultrasound parameters, serum prostate specific antigen (PSA), and CRP level were measured. A three-day void diary was recorded to identify the presence of urinary urgency. RESULTS: The mean serum CRP level was 0.24 mg/dL (range 0.01-2.84), and residual urgency was identified in 90 patients (43.9%). Patients with residual urgency were older and had significantly higher serum CRP levels (0.39 ± 0.54 mg/dL) than those without urgency (0.13 ± 0.20, P <.001). On multivariable logistic regression analysis, men with CRP levels ≥0.3 mg/dL were more likely to have urgency (odds ratio 8.08, 95% confidence interval 3.26-20.0) after adjusting for age, serum PSA level, total prostate volume, and antimuscarinic use. Patients with serum CRP levels ≥0.30 mg/dL had more urgency (82.1%) than those with serum CRP levels <0.30 mg/dL (34.9%). CONCLUSION: Serum CRP level is significantly associated with residual urgency in BPH patients after medical treatment. Chronic inflammation may play a role in the occurrence of residual urgency in BPH patients.

A new algorithm in patients with elevated and/or rising prostate-specific antigen level, minor lower urinary tract symptoms, and negative multisite prostate biopsies.

Patients with elevated and/or rising prostate-specific antigen (PSA), minor lower urinary tract symptoms (LUTS), and no evidence for prostate cancer on (multiple) extended prostate biopsies are a regularly encountered problem in urological practice. Even now, patients are seen with no objective explanation of this persistent elevated and/or rising PSA. So far, many strategic proposals have been elaborated and published to deal with this specific population including the use of different PSA derivates; applying different biopsy schemes--strategies--biopsy target imaging; diagnostic use of prostate cancer genes; and many more. In this review, we propose a new algorithm in which an urodynamic evaluation should be included since bladder outlet obstruction (BOO) can be expected. Once BOO is confirmed, a transurethral resection of the prostate (TURP) can be offered to these patients. This procedure will result in subjective and biochemical improvement and allows extensive histological examination. Current literature was reviewed with regard to this specific population. This research was performed using the commercially available Medline online search tools and applying the following search terms: "diagnostic TURP"; "elevated PSA"; and "prostate biopsy". Furthermore, subsequent reference search was executed on retrieved articles.

Reduction of prostate-specific antigen after tamsulosin treatment in patients with elevated prostate-specific antigen and lower urinary tract symptoms associated with low incidence of prostate cancer at biopsy.

OBJECTIVES: To evaluate the effect of tamsulosin on reducing the serum levels of prostate-specific antigen (PSA) in patients with lower urinary tract symptoms and an elevated PSA level. METHODS: From June 2004 to July 2006, patients with lower urinary tract symptoms, a PSA level of >or=4 ng/mL, and a maximal flow rate of <15 mL/s received tamsulosin 0.4 mg daily for 2 months. They were then scheduled for 12-core prostate biopsy. PSA determination and a uroflow study were performed before biopsy. RESULTS: A total of 80 patients completed the present study. The mean patient age was 66.3 years, and the mean PSA level was 7.8 +/- 8.4 ng/mL at baseline and 7.1 +/- 9.1 ng/mL after treatment (P < .001). A total of 29 patients (36.25%) were diagnosed with prostate cancer from the biopsy findings. A significant increment in the PSA level was observed in patients with prostate cancer (6.7 versus 7.9 ng/mL; P = .002). A significant decrease in the PSA level was observed in patients with negative biopsy findings (6.9 versus 5.1 ng/mL, P = .000). Of the 38 patients with a decrease in the PSA level, 1 (2.6%) was diagnosed with prostate cancer and 37 (97.4%) with an benign prostatic hyperplasia/prostatitis. Of the 42 patients with no change in the PSA level, 28 (66.7%) had prostate cancer and 14 (33.3%) had negative findings. A change in PSA level after treatment gave a sensitivity of 96.6%, specificity of 72.5%, and diagnostic accuracy of 81% for prostate cancer. CONCLUSIONS: Treatment with tamsulosin seemed to reduce the PSA levels and identified patients at high risk of prostate cancer.

Prospective study of the role of transurethral resection of the prostate in patients with an elevated prostate-specific antigen level, minor lower urinary tract symptoms, and proven bladder outlet obstruction.

BACKGROUND: Deciding on strategy for patients with minor lower urinary tract symptoms (LUTS), elevated prostate-specific antigen (PSA) levels, unsuspicious digital rectal examination (DRE) and/or transrectal ultrasound (TRUS), and multiple negative extended prostate biopsies is complex. OBJECTIVES: To define the role and clinical significance of transurethral resection of the prostate (TURP) in these patients. DESIGN, SETTINGS, AND PARTICIPANTS: Thirty-three patients with elevated PSA; minor LUTS, as assessed by the International Prostate Symptoms Score (IPSS); no suspicion for prostate cancer on DRE and/or TRUS; and negative extended prostate biopsies were prospectively enrolled in a cohort study at a tertiary care institution. INTERVENTION: After full urodynamic investigation showing all patients to be bladder outlet obstructed, TURP was performed. MEASUREMENTS: Resected tissue was histologically examined for presence of prostate cancer. Within 6 mo after TURP, patients were clinically reevaluated by means of IPSS and PSA level. RESULTS AND LIMITATIONS: Preoperatively, mean PSA and IPSS values were 8.2ng/ml and 6.8, respectively. Mean detrusor pressure at maximum flow was 80.3cm H(2)O. Histological examination after TURP revealed benign prostate hyperplasia in 81.8% (subgroup 1) and aggressive prostate cancer in 6.1% of patients (subgroup 2). In 12.1% of patients, only a few chips of nonaggressive prostate cancer (T1a) were detected. In patients without signs of aggressive prostate cancer (93.9%=12.1%+81.8%, subgroup 3), mean postoperative PSA and IPSS values were 0.6ng/ml and 2.4, respectively, while these values were 0.6ng/ml and 2.5ng/ml in subgroup 1 (p<0.0001). This study is limited in sample size, requiring more research to confirm these results. CONCLUSIONS: This prospective study shows that, in patients with minor LUTS and no suspicion for prostate cancer, bladder outlet obstruction can result in elevated PSA levels. These patients will benefit from TURP regarding symptomatology and supernormalisation of PSA levels. Moreover, albeit in few cases, histological examination will reveal aggressive prostate cancer.

Associations between diabetes and clinical markers of benign prostatic hyperplasia among community-dwelling Black and White men.

OBJECTIVE: The aim of this study was to examine associations between diabetes and clinical markers of benign prostatic hyperplasia (BPH) in community-dwelling white and black men aged 40-79 years. RESEARCH DESIGN AND METHODS: Data from the Olmsted County Study of Urinary Symptoms and Health Status and the Flint Men's Health Study were combined for a total study sample of 2,484 men. Severity of lower urinary tract symptoms (LUTS), peak urinary flow rates, prostate volume, and serum prostate-specific antigen (PSA) levels were examined by self-reported physician-diagnosed diabetes. RESULTS: Overall, 170 men (6.8%) reported a history of diabetes. Increased irritative LUTS and specifically nocturia were positively associated with diabetes. These patterns were consistent across race and persisted after adjustment for age, BMI, and various indicators of socioeconomic status. Furthermore, the relationship between irritative LUTS and diabetes was greater in black men. No significant associations were observed between diabetes and prostate volume, PSA level, and peak urinary flow rate. CONCLUSIONS: Our multiethnic community-based study demonstrates positive associations between diabetes and irritative LUTS and nocturia. Moreover, the association between irritative LUTS and diabetes is increased in black men. There was no strong evidence for an association between diabetes and BPH across measures more specific to BPH (i.e., prostate volume, PSA, and peak urinary flow rate). Taken together, our findings suggest that the presence of diabetes may be less related to prostate growth and more related to the dynamic components of lower urinary tract function. Further evaluations of the association between diabetes and BPH and related racial variations are warranted.

Serum sex steroid hormones and lower urinary tract symptoms in Third National Health and Nutrition Examination Survey (NHANES III).

OBJECTIVES: To evaluate the association of circulating sex steroid hormones and sex hormone binding globulin (SHBG) with lower urinary tract symptoms (LUTS). METHODS: We included 260 men, 60 years old or older, who participated in Phase 1 (1988 to 1991) of the Third National Health and Nutrition Examination Survey and for whom surplus serum was available. We measured the serum concentrations of testosterone, androstanediol glucuronide (AAG), estradiol, and SHBG. Free testosterone was calculated from the circulating testosterone, SHBG, and albumin. The cases (n = 128) were men with two to four symptoms (nocturia, hesitancy, incomplete emptying, and weak stream), but who had never undergone noncancer prostate surgery. The controls (n = 132) were men who neither had symptoms nor had undergone noncancer prostate surgery. We adjusted for age, race/ethnicity, waist circumference, cigarette smoking, alcohol consumption, and physical activity in logistic regression models and used sampling weights. RESULTS: The cases had statistically significantly greater AAG and estradiol concentrations than did the controls. After multivariate adjustment, the men in the top tertile of AAG (odds ratio 2.62, 95% confidence interval 1.12 to 6.14) had a greater risk of LUTS compared with men in the bottom two tertiles. Also, men with a greater estradiol concentration (odds ratio 1.78, 95% confidence interval 0.91 to 3.49) and a greater estradiol/SHBG molar ratio (odds ratio 2.41, 95% confidence interval 1.39 to 4.17) had a greater risk of LUTS than did men with lower concentrations. No consistent associations were seen for circulating testosterone, free testosterone, or SHBG. CONCLUSIONS: In this cross-sectional study representative of older U.S. men, circulating AAG, a metabolite of dihydrotestosterone, and estradiol were associated with an increased risk of having LUTS.

An investigation of the relationship between sex-steroid levels and urological symptoms: results from the Boston Area Community Health survey.

OBJECTIVES: To investigate whether circulating levels of sex hormones are associated with urological symptoms, using data from the Boston Area Community Health (BACH) Survey. SUBJECTS AND METHODS: BACH used a multistage stratified-cluster approach to randomly sample 5506 adults aged 30-79 years in Boston, MA, USA. Anthropometric measures, lifestyle and psychosocial factors, comorbidities and urological symptoms were obtained using a questionnaire administered by an interviewer. Serum testosterone, sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulphate (DHEAS), dihydrotestosterone (DHT) and oestradiol (E2) levels were measured, and bioavailable testosterone (BT) was calculated in 1899 men (538 Black, 651 Hispanic and 710 White). Regression analysis was used to investigate the relationships between androgen levels and American Urological Association symptom index (AUA-SI), lower urinary tract symptoms (LUTS) (> or = 8 on the AUA-SI), urinary incontinence (UI), dribble and hesitancy. RESULTS: Of all subjects, 19% reported LUTS, 6% UI, 9% dribble and 4% hesitancy. Testosterone, BT and DHEAS levels were inversely related to the AUA-SI (P = 0.009, <0.001 and <0.001, respectively); SHBG values and the AUA-SI were positively correlated (P < 0.001). Adjusting for age, BT and DHEAS levels had negative relationships with the AUA-SI; BT and DHEAS levels were negatively related to LUTS and SHBG was positively related to LUTS (both P < 0.001); after age adjustment, only LUTS and DHEAS remained related, and only the relationship between dribble and E2 remained significant; no hormone levels were related to hesitancy. CONCLUSIONS: Circulating levels of sex hormones are generally not significant predictors of urological symptoms in men after adjusting for age. The pathophysiology of LUTS is complex and probably includes factors other than circulating sex steroid levels.