Impact of Androgen Deprivation Therapy on Volume Reduction and Lower Urinary Tract Symptoms in Patients with Prostate Cancer

Washino, Satoshi; Hirai, Masaru; Saito, Kimitoshi; Kobayashi, Yutaka; Arai, Y.; Miyagawa, Tomoaki

doi:10.1111/luts.12142

Cited by 18 publications

(22 citation statements)

References 36 publications

(53 reference statements)

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“…It is assumed that NAHT-induced tumor involution allows for effective sparing of critical structures and therefore minimizes treatment-related morbidities. 31 Conversely, concern remains with commencing ADT concurrently with RT, because this might cause inconsistency in dose to critical structures as a result of dynamic changes in the size and shape of the prostate over the course of RT. We did not find any differences in RT-induced toxicity between the arms.…”

Section: Discussionmentioning

confidence: 99%

Sequencing of Androgen-Deprivation Therapy With External-Beam Radiotherapy in Localized Prostate Cancer: A Phase III Randomized Controlled Trial

Malone

Roy

Eapen

et al. 2020

JCO

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PURPOSE Dose-escalated radiotherapy (RT) with androgen-deprivation therapy (ADT) is a standard definitive treatment of localized prostate cancer (LPCa). The optimal sequencing of these therapies is unclear. Our phase III trial compared neoadjuvant versus concurrent initiation of ADT in combination with dose-escalated prostate RT (PRT). PATIENTS AND METHODS Patients with newly diagnosed LPCa with Gleason score ≤ 7, clinical stage T1b to T3a, and prostate-specific antigen < 30 ng/mL were randomly allocated to neoadjuvant and concurrent ADT for 6 months starting 4 months before RT (neoadjuvant group) or concurrent and adjuvant ADT for 6 months starting simultaneously with RT (concurrent group). The primary end point was biochemical relapse-free survival (bRFS). Stratified log-rank test was used to compare bRFS and overall survival (OS). Incidence of grade ≥ 3 late RT-related toxicities was compared by log-rank test. RESULTS Overall, 432 patients were randomly assigned to the neoadjuvant (n = 215) or concurrent group (n = 217). At 10 years, bRFS rates for the two groups were 80.5% and 87.4%, respectively. Ten-year OS rates were 76.4% and 73.7%, respectively. There was no significant difference in bRFS ( P = .10) or OS ( P = .70) between the two groups. Relative to the neoadjuvant group, the hazard ratio for the concurrent group was 0.66 (95% CI, 0.41 to 1.07) for bRFS and 0.94 (95% CI, 0.68 to 1.30) for OS. No significant difference was observed in the 3-year incidence of late RT-related grade ≥ 3 GI (2.5% v 3.9%) or genitourinary toxicity (2.9% v 2.9%). CONCLUSION In our study, there was no statistically significant difference in bRFS between the two treatment groups. Similarly, no difference was seen in OS or late RT-related toxicities. On the basis of these results, both neoadjuvant and concurrent initiations of short-term ADT with dose-escalated PRT are reasonable standards of care for LPCa.

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Section: Discussionmentioning

confidence: 99%

Sequencing of Androgen-Deprivation Therapy With External-Beam Radiotherapy in Localized Prostate Cancer: A Phase III Randomized Controlled Trial

Malone

Roy

Eapen

et al. 2020

JCO

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“…Conversely, there is little research to elucidate the effect of testosterone on nocturia during androgen deprivation therapy (ADT) where FVCs and general health condition (including hot flush) were simultaneously evaluated. We found some research explaining the effect of ADT, including an interesting recent study conducted by Washino et al 5 The authors concluded that ADT significantly reduced total prostate volume and improved lower urinary tract symptoms in patients with prostate cancer and moderate to severe lower urinary tract symptoms, but increased nocturia in patients with mild lower urinary tract symptoms. These results were impressive, but we cannot determine whether it is nocturnal frequency or nocturnal polyuria that was improved in their study cohorts.…”

Section: Main Textmentioning

confidence: 88%

“…In our recent experience with 30 prostate cancer patients with two or more nocturia, who took hormone deprivation therapy (leuprorelin acetate with bicalutamide) without any additional treatment for prostate cancer, the frequency of nocturia did not change even after testosterone dropped under castrated level (the mean frequency of nocturia changed from 3.10 ± 0.92 to 3.03 ± 0.85 with a P value of .645, and the nocturnal urine volume in the FVC changed from 271.53 ± 85.55 to 277.27 ± 84.57 with a P value of .481), which is found to be consistent with the previous research. 5 In future studies, we hope that researchers will include the evaluation of the FVCs as well as lower urinary tract factors such as prostate size in their studies to investigate the effect of testosterone on nocturia. Not only basic researches are essential to clarify this point but also large prospective clinical studies are required.…”

Section: Main Textmentioning

confidence: 99%

Re: Impact of androgen deprivation therapy on volume reduction and lower urinary tract symptoms in patients with prostate cancer

Shin

Lee

2020

LUTS

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“…However, because of the different methods used in the present study, there are some differences from those previous studies. For example, two other Asian prospective studies showed an improvement of lower urinary tract symptoms (LUTS) in prostate cancer patients who received ADT (14,15). Their finding focused on prostate volume decrease, urodynamic parameters and improvement of voiding scores while the storage symptom scores were not different.…”

Section: Discussionmentioning

confidence: 99%

Positive Association of Male Overactive Bladder Symptoms and Androgen Deprivation: A Nationwide Population-based Cohort Study

Wang

Lin

et al. 2018

Anticancer Res

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Background/Aim: The role of androgen in the modulation of voiding function is still uncertain. The aim of this study was to evaluate the association of androgen deprivation therapy (ADT) and overactive bladder (OAB) in men in a population-based cohort. Materials and Methods: This study examined the records of newly-diagnosed prostate cancer subjects receiving ADT only in the Taiwan National Health Insurance Research Database in the years between 2001 and 2007.As controls men without cancer were selected and divided into three groups, 1) benign prostate hyperplasia treated with an alpha-blocker (BPH-alpha blocker), 2) BPH treated with a 5alpha reductase inhibitor (BPH-5ARI) and 3) healthy controls. OAB events were censored by definition of drug prescriptions for more than one month and risk analysis among each group was performed. Results: The healthy control group had decreased risk of OAB compared to the prostate cancer group and the BPH-5ARI group showed a higher risk of OAB than the prostate cancer group. Subgroup analysis showed that independently of age or comorbidities, the prevalence of OAB was significantly lower in the healthy control group. Moreover, the cumulative incidence of OAB showed a time-dependent pattern with a significant increase after ADT for 5 years. Conclusion: Androgen deprivation in prostate cancer patients was associated with an increased risk of OAB that was treatment duration-dependent. This result is consistent with an inhibitory role of androgen in the modulation of male voiding function.Sex hormones including androgen and estrogen bind to steroid receptors that are widely distributed in human tissues (1, 2). In genitourinary tract, sex hormones not only control the appearance and function of sex organs, but may also influence lower urinary tract function (3). Our previous human population cohort studies as well as experimental studies on female rats suggested that estrogen may influence the voiding function in females (4, 5). However, the role of androgen in the modulation of male voiding functions is less certain. Epidemiological studies showed that aging which is accompanied by decreased serum testosterone levels (6, 7) is also associated with increased prevalence of overactive bladder (OAB). We also showed that orchiectomy decreased the volume threshold for inducing micturition in a rat model (8). Based on current evidence, serum testosterone seems to play a role in the modulation of voiding function in men (9). However, a relationship between serum testosterone level and OAB has not been established.In this study, a nationwide population-based insurance database was used to examine a possible link between androgen deprivation therapy (ADT) and OAB in prostate cancer patients. The data were compared with data obtained from healthy controls and from patients with benign prostate hyperplasia (BPH). Materials and MethodsData sources.

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Impact of Androgen Deprivation Therapy on Volume Reduction and Lower Urinary Tract Symptoms in Patients with Prostate Cancer

Abstract: In this study, we observed that ADT significantly reduced TPV and improved LUTS in patients with PCa and moderate to severe LUTS, but increased nocturia in patients with mild LUTS.

Cited by 18 publications

References 36 publications

Sequencing of Androgen-Deprivation Therapy With External-Beam Radiotherapy in Localized Prostate Cancer: A Phase III Randomized Controlled Trial

Sequencing of Androgen-Deprivation Therapy With External-Beam Radiotherapy in Localized Prostate Cancer: A Phase III Randomized Controlled Trial

Re: Impact of androgen deprivation therapy on volume reduction and lower urinary tract symptoms in patients with prostate cancer

Positive Association of Male Overactive Bladder Symptoms and Androgen Deprivation: A Nationwide Population-based Cohort Study

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