Severe lower urinary tract symptoms (LUTS) are associated with an increased risk of developing bladder cancer, new findings suggest.

In a study of 30,183 men in the Health Professionals Follow-up Study (HPFS), men with severe LUTS had a 64% higher relative risk of bladder cancer compared with men who did not have LUTS in multivariate analysis. Men who had both voiding and storage dysfunction had a significant 60% higher risk of bladder cancer. 

In addition, among individual urinary symptoms, urinary hesitancy was strongly associated with bladder cancer risk. Men who had urinary hesitancy at least 50% of the time had a 2.2 times increased risk, a team led by Dominique S. Michaud, ScD, of Tufts University Medical School in Boston, reported online ahead of print in Urology.

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Dr. Michaud and her colleagues concluded that their findings suggest that urinary voiding symptoms may raise the risk of bladder cancer. “If this association is confirmed,” they wrote, “LUTS might be used as a simple test to identify men who are at higher risk of bladder cancer.”

The investigators pointed out that about 15%–60% of men older than 40 years report suffering from LUTS in various studies, with the prevalence and severity increasing with age.

Investigators used a slightly modified American Urological Association Symptom Score Index (AUA-7) to assess LUTS information. The index consists of 7 questions assessing storage and voiding dysfunction symptoms. Each question is scored on a 0–5 scale, with 0, 1, 2, 3, 4, 5 corresponding, respectively, to 0%, 10%, 25%, 50%, 75%, and almost 100% of the time that a symptom was experienced. The maximum possible total score is 35. Patients with AUA-7 scores greater than 1 but not more than 7, higher than 7 but not more than 19, and higher than 19 had mild, moderate, and severe LUTS, respectively.

At baseline, 1,892 men reported experiencing urinary hesitance for at least 50% of the time, among which 1,069 men (56.5%) had mixed storage and voiding dysfunctions and 642 (33.9%) had isolated voiding dysfunction, according to the investigators. Men reporting experiencing hesitance for at least 50% of the time had the highest overall total AUA-7 score.

“These results suggest that the presence of severe urinary hesitancy might indicate higher volume of post-void residual urine, which can increase the contact time of potential carcinogens in urine and the bladder urothelium and the risk of bladder cancer,” they wrote.

Previous studies have revealed bladder wall thickening and bladder mass increases among men with LUTS, Dr. Michaud’s group noted.

The researchers found that men who urinated 3 or more times per night had a nonsignificant 18% decreased risk of bladder cancer compared with men who had no nighttime urination.

Initiated in 1986, the HPFS enrolled 51,529 male health professionals aged 40–75 years from across the United States.