LUTS in men - It’s not all about the prostate

Jim is a fit 73 year old whom you don’t see much of, but he’s here to talk about his prostate. He’s a keen gardener, and apart from well controlled hypertension on amlodipine and ramipril he has little past medical history. He’s had some slowly developing LUTS over the past few years - a slight increase in day frequency and getting up 1-2 times at night, a slight reduction in his urine flow, and some intermittent urgency. ‘I think it’s my prostate - I’ve been reading in the papers that I should get it checked’.

We see a lot of Jims - even more so as discussions around prostate cancer and PSA testing have been a hot topic in both the general and medical press. But while addressing the prostate cancer issue is obviously important, there is a real risk that this can sideline the reason men come to see us in the first place - bothersome LUTS that they want help with. It is estimated that at least 30% of men over the age of 65 have bothersome LUTS, but many do not seek help, so addressing their symptoms when they do present is important.

This issue was highlighted in a BJGP article from a few years ago, which also addressed the importance of conservative measures for men with LUTS. Despite NICE (CG97) recommending conservative measures for men with LUTS, audit data suggests this often does not happen. Why? As always there’s a range of reasons, one being a focus on prostate cancer risk and not addressing the presenting symptoms, but we will all know the major barrier is time - trying to advise on detailed conservative measures on top of addressing cancer concerns, assessing the LUTS, examining and considering investigations is well nigh impossible in a standard GP appointment. 

But help is at hand…The TRIUMPH study  was published back in 2023 and got little air time, but a NIHR alert flagged in the BMJ earlier this year (BMJ 2025;388:q2660) highlights the importance of this study and it’s relevance to General Practice. The TRIUMPH study was a UK based primary care RCT that randomised ~1000 men with LUTS to usual care or the addition of self-management advice with a patient booklet. Those with the additional self-management advice and booklet had a small but statistically significant improvement in symptoms with better quality of life at 12 months, although referral rates to urology were similar. The researchers then did a parallel qualitative study which showed that men who had been given the booklet felt they had a better understanding of their urinary symptoms and importantly appreciated that their symptoms were being taken seriously and not just being dismissed as a normal part of getting older, in contrast to the usual care group. 

The caveat is that the self-management group with the booklet did have 3 follow up calls with a nurse or HCA, which we would struggle to replicate in routine General Practice, but this study does highlight that self-management advice can be helpful, and importantly that this booklet could be a useful aid for us to give men to help with bothersome LUTS. It’s a really good booklet, broken up into different sections so men can focus on the symptoms most bothersome to them e.g. ‘controlling bladder leakage’ or ‘getting rid of the last drops’ - click here for the booklet. A useful supplementary summary sheet from the BAUS for men with LUTS is also worth highlighting - click here.

So back to Jim. Although he does want a PSA check, he admits the prostate cancer discussion was really an ‘in’ to talk about his LUTS, as he was worried they would just be perceived or dismissed as a normal part of growing older. It turns out the trigger for seeing you is that the intermittent urgency is playing havoc with his gardening. He’s nearly got caught short on a number of occasions so is reluctant to go to his allotment, which is really upsetting him. A very quick check of triggers highlights that since retiring his one cup of coffee in the morning is now stretching to 3 or 4, which you briefly discuss as a likely factor. You send him a copy of the LUTS self-management booklet for more details to help with his symptoms and suggest a 3 month review if things aren’t improving. Jim is clearly happy his symptoms have been validated, and is looking forward to tackling the allotment again.