Natural History of Prostatism: The Olmsted County Study

Summary

Principal Investigator: JENNIFER LYNN ST SAUVER
Abstract: Benign prostatic hyperplasia (BPH) is an extremely common clinical syndrome in aging men that is characterized by a constellation of signs and lower urinary tract symptoms which can have a dramatic negative impact on quality of life and serious long-term sequelae. Once considered a normal concomitant of aging, with surgical treatment the only option, new minimally invasive and pharmacologic therapies permit earlier intervention and have led to a critical need to better understand its development and progression. To this end, we have been performing biennial examinations, with standardized instruments and protocols, on a cohort of over 2000 randomly selected Olmsted County Minnesota men since 1990. These population- based data permit inferences that are not subject to the selection biases present in most previous studies. These efforts have allowed us to, in many ways, define the epidemiology of BPH with respect to the rate of onset and progression of BPH in community-dwelling men, its impact on long-term outcomes (e.g., acute urinary retention, chronic kidney disease) and quantified its impact on quality of life. These insights have proven extremely valuable in designing intervention studies, and putting their results in the community context. Nonetheless, with each new insight, important new questions arise. In this next funding period, we will build on our findings of cross-sectional associations between BPH and circulating sex steroid levels as well as polymorphisms in genes encoding proteins involved in steroid metabolism and action. Based on our extensive longitudinal phenotypic information, banked DNA and serum samples and genotype information, we are ideally poised to now determine how changes in hormone levels are related to changes in measures of BPH and how these genetic polymorphisms modify these associations. We will also investigate the population distributions of Prostate Specific Antigen(PSA) species (e.g. BPSA and pro-PSA), which may improve our ability to differentiate between men with cancer, BPH and normal prostates. And, by adding three new sonographic measurements (i.e. estimated total bladder weight and intravesical prostatic protrusion and presumed circle area ratio) to our protocol we will be able to evaluate their prognostic value from a population perspective, that will help us understand how they should be used in new large-scale clinical trials. Finally, through continued passive followup of this cohort, and a population-based cohort of men newly-diagnosed with BPH, through their community medical records, we will inform a major controversy about the risks and outcomes associated with acute urinary retention. Thus, with the completion of these aims, our multi-disciplinary team will build on our fifteen years of experience, unparalleled clinical data and cutting edge laboratory measurements to further our understanding of this chronic, progressive and important disease, from a population perspective that is free from many of the biases inherent in studies conducted in referral or other clinical practices. Public Health Relevance: We will use state-of-the-art clinical and laboratory methods to address important questions about how genes, hormones and other factors play a role in the development and progression of BPH, with a goal of understanding how this common and extremely bothersome condition might be avoided.
Funding Period: ----------------2000 - ---------------2011-
more information: NIH RePORT

Top Publications

  1. ncbi Polymorphisms in genes involved in sex hormone metabolism may increase risk of benign prostatic hyperplasia
    Rosebud O Roberts
    Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
    Prostate 66:392-404. 2006
  2. pmc Racial differences in longitudinal changes in serum prostate-specific antigen levels: the Olmsted County Study and the Flint Men's Health Study
    Aruna V Sarma
    Department of Urology, University of Michigan, Ann Arbor, MI Electronic address
    Urology 83:88-93. 2014
  3. pmc The effect of benign lower urinary tract symptoms on subsequent prostate cancer testing and diagnosis
    Christopher J Weight
    University of Minnesota, Department of Urology, Minneapolis, MN 55455, USA
    Eur Urol 63:1021-7. 2013
  4. pmc Psychosocial factors associated with an increased frequency of prostate cancer screening in men ages 40 to 79 years: the Olmsted County study
    Lauren P Wallner
    Departments of Epidemiology and Urology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
    Cancer Epidemiol Biomarkers Prev 17:3588-92. 2008
  5. pmc The associations between serum sex hormones, erectile function, and sex drive: the Olmsted County Study of Urinary Symptoms and Health Status among Men
    Naomi M Gades
    Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
    J Sex Med 5:2209-20. 2008
  6. pmc Longitudinal association between prostatitis and development of benign prostatic hyperplasia
    Jennifer L St Sauver
    Urology 71:475-9; discussion 479. 2008
  7. pmc Snoring as a risk factor for sexual dysfunction in community men
    Viktor Hanak
    Mayo Clinic Pulmonary and Critical Care Medicine, Rochester, MN, USA
    J Sex Med 5:898-908. 2008
  8. ncbi Associations between diabetes and clinical markers of benign prostatic hyperplasia among community-dwelling Black and White men
    Aruna V Sarma
    Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
    Diabetes Care 31:476-82. 2008
  9. ncbi Growth factor, cytokine, and vitamin D receptor polymorphisms and risk of benign prostatic hyperplasia in a community-based cohort of men
    Rebecca J Mullan
    Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
    Urology 67:300-5. 2006
  10. ncbi Correlations between longitudinal changes in transitional zone volume and measures of benign prostatic hyperplasia in a population-based cohort
    Jennifer L St Sauver
    Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
    Eur Urol 50:105-11. 2006

Scientific Experts

  • JENNIFER LYNN ST SAUVER
  • Lauren P Wallner
  • Aruna V Sarma
  • Debra J Jacobson
  • Michael M Lieber
  • Steven J Jacobsen
  • Michaela E McGree
  • Cynthia J Girman
  • Thomas Rhodes
  • Naomi M Gades
  • George G Klee
  • Ajay Nehra
  • Christopher J Weight
  • Kitaw Demissie
  • R Jeffrey Karnes
  • Rosebud O Roberts
  • Simon P Kim
  • Amy E Krambeck
  • Rodney H Breau
  • Andrew D Rule
  • Brant A Inman
  • Rajeev Kumar
  • Viktor Hanak
  • Rebecca J Mullan
  • Sara A Farmer
  • Scott J Hebbring
  • Julie M Cunningham
  • Stephen N Thibodeau
  • Stephen A Boorjian
  • Bradley C Leibovich
  • R Houston Thompson
  • Deborah J Lightner
  • Alexander S Parker
  • Veronique L Roger
  • Jennifer L St Sauver
  • Virend K Somers
  • Jennifer St Sauver
  • Eric J Olson
  • Erik J Bergstralh
  • Eric J Bergstralh

Detail Information

Publications38

  1. ncbi Polymorphisms in genes involved in sex hormone metabolism may increase risk of benign prostatic hyperplasia
    Rosebud O Roberts
    Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
    Prostate 66:392-404. 2006
    ..This study investigates associations between polymorphisms in genes involved in sex hormone metabolism and measures of benign prostatic hyperplasia (BPH)...
  2. pmc Racial differences in longitudinal changes in serum prostate-specific antigen levels: the Olmsted County Study and the Flint Men's Health Study
    Aruna V Sarma
    Department of Urology, University of Michigan, Ann Arbor, MI Electronic address
    Urology 83:88-93. 2014
    ..To determine the distribution of, and racial differences in, changes in prostate-specific antigen (PSA) from a population-based sample of men...
  3. pmc The effect of benign lower urinary tract symptoms on subsequent prostate cancer testing and diagnosis
    Christopher J Weight
    University of Minnesota, Department of Urology, Minneapolis, MN 55455, USA
    Eur Urol 63:1021-7. 2013
    ..Lower urinary tract symptoms (LUTS) are common and have been associated with the subsequent diagnosis of prostate cancer (PCa) in population cohorts...
  4. pmc Psychosocial factors associated with an increased frequency of prostate cancer screening in men ages 40 to 79 years: the Olmsted County study
    Lauren P Wallner
    Departments of Epidemiology and Urology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
    Cancer Epidemiol Biomarkers Prev 17:3588-92. 2008
    ..6; 95% CI, 0.2-1.8). These data suggest that psychosocial factors such as family history, worry, or concern about prostate cancer and marital status may play an important role in men's decisions about prostate cancer screening...
  5. pmc The associations between serum sex hormones, erectile function, and sex drive: the Olmsted County Study of Urinary Symptoms and Health Status among Men
    Naomi M Gades
    Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
    J Sex Med 5:2209-20. 2008
    ..Testosterone replacement therapy has been used in the treatment of sexual dysfunction; however, its use remains controversial, and the effectiveness and long-term health implications are unknown...
  6. pmc Longitudinal association between prostatitis and development of benign prostatic hyperplasia
    Jennifer L St Sauver
    Urology 71:475-9; discussion 479. 2008
    ..To determine whether physician-diagnosed prostatitis was associated with later development of benign prostatic hyperplasia (BPH)-associated events in a longitudinal, population-based sample of 2447 men residing in Olmsted County, Minnesota...
  7. pmc Snoring as a risk factor for sexual dysfunction in community men
    Viktor Hanak
    Mayo Clinic Pulmonary and Critical Care Medicine, Rochester, MN, USA
    J Sex Med 5:898-908. 2008
    ..Severe obstructive sleep apnea has been associated with sexual dysfunction; however, it is unclear whether milder forms of sleep disturbances might also be associated with sexual problems...
  8. ncbi Associations between diabetes and clinical markers of benign prostatic hyperplasia among community-dwelling Black and White men
    Aruna V Sarma
    Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
    Diabetes Care 31:476-82. 2008
    ..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...
  9. ncbi Growth factor, cytokine, and vitamin D receptor polymorphisms and risk of benign prostatic hyperplasia in a community-based cohort of men
    Rebecca J Mullan
    Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
    Urology 67:300-5. 2006
    ..To investigate the associations between benign prostatic hyperplasia (BPH) and polymorphisms in genes that encode growth factors, cytokines, and vitamin D and their receptors...
  10. ncbi Correlations between longitudinal changes in transitional zone volume and measures of benign prostatic hyperplasia in a population-based cohort
    Jennifer L St Sauver
    Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
    Eur Urol 50:105-11. 2006
    ..To determine whether measures of transitional zone volume (TZV) are more strongly associated than total prostate volume with longitudinal urologic outcomes...
  11. pmc Men (aged 40-49 years) with a single baseline prostate-specific antigen below 1.0 ng/mL have a very low long-term risk of prostate cancer: results from a prospectively screened population cohort
    Christopher J Weight
    Department of Urology, University of Minnesota, MN Electronic address
    Urology 82:1211-7. 2013
    ..To study the use of a baseline prostate-specific antigen (PSA) and digital rectal examination in men (aged 40-49 years) in predicting long-term prostate cancer risk in a prospectively followed, representative population cohort...
  12. ncbi Tracking of longitudinal changes in measures of benign prostatic hyperplasia in a population based cohort
    Jennifer L St Sauver
    Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
    J Urol 175:1018-22; discussion 1022. 2006
    ..We characterized how longitudinal changes in PSA, prostate size, maximum urinary flow rates and lower urinary tract symptoms track together over time...
  13. pmc Dropout in a longitudinal, cohort study of urologic disease in community men
    Naomi M Gades
    Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
    BMC Med Res Methodol 6:58. 2006
    ..Factors associated with dropout were evaluated in a twelve-year community-based, prospective cohort study of urologic disease in men...
  14. ncbi Protective association between nonsteroidal antiinflammatory drug use and measures of benign prostatic hyperplasia
    Jennifer L St Sauver
    Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
    Am J Epidemiol 164:760-8. 2006
    ..Results suggest that NSAID use may prevent or delay development of benign prostatic hyperplasia...
  15. pmc Presumed circle area ratio of the prostate in a community-based group of men
    Jennifer L St Sauver
    Mayo Clinic, Department of Health Sciences Research, Division of Epidemiology, Rochester, MN, USA
    BJU Int 104:58-62. 2009
    ..95, 95% confidence interval 1.39-6.25, and 3.47, 1.63-7.39, respectively). CONCLUSION PCAR might add further information beyond total prostate volume when predicting the development of obstructive LUTS...
  16. pmc Associations between longitudinal changes in serum estrogen, testosterone, and bioavailable testosterone and changes in benign urologic outcomes
    Jennifer L St Sauver
    Division of Epidemiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
    Am J Epidemiol 173:787-96. 2011
    ..These results suggest that both absolute sex steroid hormone levels and the rates at which the levels change may be important in the development of urologic conditions in aging men...
  17. pmc Associations between variants in the cyclooxygenase 2 enzyme gene (PTGS2) and development of benign prostate enlargement
    Jennifer L St Sauver
    Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
    BJU Int 108:1610-5. 2011
    ....
  18. pmc Associations between modest weight changes and onset and progression of lower urinary tract symptoms in two population-based cohorts
    Jennifer L St Sauver
    Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
    Urology 78:437-41. 2011
    ..To conduct a study to determine whether weight changes were associated with the risk of developing lower urinary tract symptoms (LUTS). Obesity has been associated with LUTS in aging men...
  19. pmc Distribution and associations of [-2]proenzyme-prostate specific antigen in community dwelling black and white men
    Thomas Rhodes
    Department of Epidemiology, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey, USA
    J Urol 187:92-6. 2012
    ..We also describe associations with clinical urological measures and the risk of prostate cancer diagnosis...
  20. pmc Benign prostate specific antigen distribution and associations with urological outcomes in community dwelling black and white men
    Thomas Rhodes
    Department of Epidemiology, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey, USA
    J Urol 187:87-91. 2012
    ..We describe cross-sectional associations of benign prostate specific antigen with clinical urological measures and examined the risk of future urological outcomes in 2 population based cohorts of black and white men, respectively...
  21. pmc Sixteen-year longitudinal changes in serum prostate-specific antigen levels: the olmsted county study
    Steven J Jacobsen
    Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
    Mayo Clin Proc 87:34-40. 2012
    ..To determine the distribution of longitudinal changes in serum prostate-specific antigen (PSA) levels from a population-based sample of men...
  22. pmc Longitudinal changes of benign prostate-specific antigen and [-2]proprostate-specific antigen in seven years in a community-based sample of men
    Thomas Rhodes
    Department of Epidemiology, University of Medicine and Dentistry in New Jersey, Piscataway, New Jersey, USA
    Urology 79:655-61. 2012
    ..These markers have been shown to be predictive of prostate cancer (CaP) and benign prostatic hyperplasia treatment; however, little is known about longitudinal changes in these markers...
  23. pmc Effectiveness of medical and surgical therapies for lower urinary tract symptoms in the community setting
    Amy E Krambeck
    Department of Urology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
    BJU Int 110:1332-7. 2012
    ..Our findings show that in this community medical management was poor at symptomatic improvement, whereas surgical intervention produced the best improvement...
  24. pmc The effects of body mass index on changes in prostate-specific antigen levels and prostate volume over 15 years of follow-up: implications for prostate cancer detection
    Lauren P Wallner
    Department of Urology, University of Michigan, Ann Arbor, MI, USA
    Cancer Epidemiol Biomarkers Prev 20:501-8. 2011
    ....
  25. pmc The effects of type 2 diabetes and hypertension on changes in serum prostate specific antigen levels: results from the Olmsted County study
    Lauren P Wallner
    Department of Epidemiology, University of Michigan, Ann Arbor, MI 48105 2967, USA
    Urology 77:137-41. 2011
    ..Therefore, the goal of this study was to assess associations between type 2 diabetes and hypertension and changes in serum PSA levels...
  26. pmc The effects of metabolic conditions on prostate cancer incidence over 15 years of follow-up: results from the Olmsted County Study
    Lauren P Wallner
    Department of Urology, University of Michigan, Ann Arbor, MI, USA
    BJU Int 107:929-35. 2011
    ..To determine if combinations of obesity, hypertension and diabetes influence the development of prostate cancer over 15 years of follow-up...
  27. pmc Associations between C-reactive protein and benign prostatic hyperplasia/lower urinary tract symptom outcomes in a population-based cohort
    Jennifer L St Sauver
    Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
    Am J Epidemiol 169:1281-90. 2009
    ..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...
  28. pmc Alpha-blocker use is associated with decreased risk of sexual dysfunction
    Rajeev Kumar
    Department of Urology, All India Institute of Medical Sciences, New Delhi, India
    Urology 74:82-7. 2009
    ..If sexual dysfunction and LUTS share a common etiology, alpha-blocker use might also be associated with a decreased risk of sexual dysfunction...
  29. pmc Longitudinal evaluation of sexual function in a male cohort: the Olmsted county study of urinary symptoms and health status among men
    Naomi M Gades
    Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
    J Sex Med 6:2455-66. 2009
    ..Long-term data showing how changes in multiple sexual function domains track together may be useful in understanding the importance of physical declines vs. sexual satisfaction...
  30. pmc Natural history of benign prostatic enlargement: long-term longitudinal population-based study of prostate volume doubling times
    Michael M Lieber
    Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
    BJU Int 105:214-9. 2010
    ..To measure prostate volume doubling times (PVDTs) for a large sample of community men followed serially by transrectal ultrasonography (TRUS), and to determine whether specific characteristics are associated with a rapid PVDT...
  31. pmc Three-dimensional ultrasound bladder characteristics and their association with prostate size and lower urinary tract dysfunction among men in the community
    Andrew D Rule
    Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA
    Urology 74:908-13. 2009
    ..To characterize ultrasound bladder measures, and to determine whether these measures were associated with measures of lower urinary tract dysfunction...
  32. pmc A population-based, longitudinal study of erectile dysfunction and future coronary artery disease
    Brant A Inman
    Duke University Medical Center, Durham, NC, USA
    Mayo Clin Proc 84:108-13. 2009
    ..To assess the association between erectile dysfunction (ED) and the long-term risk of coronary artery disease (CAD) and the role of age as a modifier of this association...
  33. pmc Intravesical prostatic protrusion in men in Olmsted County, Minnesota
    Michael M Lieber
    Department of Urology, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
    J Urol 182:2819-24. 2009
    ....
  34. pmc The association between statin use and the diagnosis of prostate cancer in a population based cohort
    Rodney H Breau
    Department of Urology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
    J Urol 184:494-9. 2010
    ..The effect of statin medication use on the risk of prostate cancer is unknown...
  35. pmc Estimation of prostate size in community-dwelling men
    Debra J Jacobson
    Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
    Urology 77:422-6. 2011
    ....
  36. pmc Smoking and acute urinary retention: the Olmsted County study of urinary symptoms and health status among men
    Aruna V Sarma
    Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan 48109 0759, USA
    Prostate 69:699-705. 2009
    ..We hypothesized that acute urinary retention (AUR), an adverse outcome of this disease and indication for surgical treatment, may be related to smoking...
  37. pmc Statin use and decreased risk of benign prostatic enlargement and lower urinary tract symptoms
    Jennifer L St Sauver
    Division of Epidemiology, Departments of Urology and Health Sciences Research and Cardiology, Mayo Clinic College of Medicine, Rochester, MN, USA
    BJU Int 107:443-50. 2011
    ..To determine whether statin use is associated with a decreased risk of developing benign prostatic enlargement (BPE) and lower urinary tract symptoms (LUTS)...