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Antioxidants: Is It Simply Too Late Once Lower Urinary Tract Symptoms Are Established?

  • Marcus J. Drake

Publication: European Urology Focus 2015 Oct 21

PII: S2405-4569(15)00151-0

DOI: 10.1016/j.euf.2015.09.009

Antioxidants must be presumed to have their greatest effect on disease prevention, acting to oppose the harmful effects of oxidants and thereby maintain health. Once the harm of oxidants has already been done, it seems doubtful that antioxidants would actually reverse established pathophysiology. Because people are exposed to oxidants throughout life, use of antioxidants would presumably be needed early in life to derive actual benefit. Taking an antioxidant too late may be little more helpful than putting on a lead apron after the x-ray source has been activated; both are like closing the stable door after the horse has bolted.

In this month's issue of European Urology Focus, antioxidants were given to men aged >65 yr within a study that primarily investigated osteoporotic fractures [1] . The prevalence of lower urinary tract symptoms (LUTS) in this age group is clearly considerable, and little difference was seen subsequent to antioxidant use. Accordingly, we have to conclude that any beneficial use of antioxidants is marginal or nonexistent for attempts to reverse established LUTS in older men or to reduce LUTS progression.

In use, it is implicit that sufficient levels of antioxidants need to be present in the peripheral tissues at the time of oxidant exposure. Because exposure to oxidants seems to be a commonplace event, whether from food or environmental encounter, antioxidant dosing and compliance with treatment would need to ensure sufficient antioxidant levels within the lower urinary tract (indeed, throughout the body) pretty much at all times. People, however, are rather faddish with their health drives and probably cannot be expected to sustain the necessary intake of antioxidants conscientiously for the majority of the time. Reliably taking antioxidants early in life, when they arguably would give most benefit, is not likely to be typical. Furthermore, preventing onset of LUTS is unlikely to be a motivating factor for younger people with normal urinary function. It is only people actually suffering with LUTS who generally understand their impact and thus are likely to have the motivation to take preventive measures against LUTS progression. The younger group seems more likely to have the best chance of benefit.

The possibility that antioxidants would make a difference is appealing and seemingly plausible, but the reality of genuine response depends on so many factors that it is probably unrealistic for an older age group with a complex problem like LUTS. The authors must be commended for taking on this subject with a rigorous scientific study [1] . It is also commendable that they reached their credible conclusions efficiently by including LUTS measurement as part of a wider study into medical influences, principally osteoporosis.

The authors allude to the possibility that use of a Block Food Frequency Questionnaire with “only 69” food items potentially biased the study to the null hypothesis. The comparatively crude symptom score (overall American Urological Association Symptom Index [AUA-SI]) is another aspect that could limit the sensitivity of the study. Pooling the AUA-SI and grouping into mild, moderate, or severe leaves out the potential to undertake intriguing subanalysis of storage versus voiding or postmicturition LUTS. It is perfectly possible that benefits with antioxidant therapy may differ between bladder and prostate, and more discriminating LUTS analysis is desirable, accordingly. Publication of the effect on micturition cycle phase response is to be hoped for, since it may give insight into the influence of antioxidants in the individual lower urinary tract organs.

The author is on advisory boards, is a speaker, and participates in research for Allergan, Astellas, and Ferring.

  • [1] Holton KF, Marshall LM, Shannon J, et al. Osteoporotic Fractures in Men Study Group. Dietary antioxidants and longitudinal changes in lower urinary tract symptoms in elderly men: the osteoporotic fractures in men study. Eur Urol Focus. In press. http://dx.doi.org/10.1016/j.euf.2015.09.006