DO PROSTATE SIZE AND URINARY FLOW-RATES PREDICT HEALTH CARE-SEEKING BEHAVIOR FOR URINARY SYMPTOMS IN MEN

Objectives. To estimate the association between health care-seeking be havior 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 administe red a previously validated questionnaire that assessed the frequency o f 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 docto r in the past year for urinary symptoms. Men with moderate to severe s ymptoms (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 symptom s. Men with enlarged prostates (>40 mL) were 3.9 times as likely to ha ve 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 hav e 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 prostat ic enlargement, depressed peak urine flow rates, or moderate-severe sy mptoms (sensitivity). In contrast, only 55% of men who did not seek he alth care for urinary symptoms in the past year had mild symptoms, nor mal prostatic volume, and normal peak urine flow rates (specificity). Conclusions. These data suggest that clinical, physiologic, and anatom ic measures of prostatism do not adequately distinguish the men who se ek medical care for their urinary symptoms from those who do not. Ther e remain some factor(s) that apparently lead some men with minor disea se to seek care and that prevent men with measurable disease from seek ing care.