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

Abstract

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.

Clinical significance of prostate volume and testosterone reduction on lower urinary tract symptoms in patients with prostate cancer undergoing androgen deprivation therapy

“…The higher serum levels of testosterone generated by testosterone supplementation were associated with reduced IPSS, probably indicating a correlation between serum testosterone level and their effects on LUTS 21 . Especially, lower IPSS-ss were reported in patients with testosterone supplementation than control by a more recent study based on a large registry data 22 , 23 . In the same context, an Asian study that investigated the relationship between male overactive bladder (OAB) symptoms and androgen deprivation revealed that ADT in patients with PCa was associated with an increased risk of OAB that was ADT duration-dependent 23 .…”

“…Especially, lower IPSS-ss were reported in patients with testosterone supplementation than control by a more recent study based on a large registry data 22 , 23 . In the same context, an Asian study that investigated the relationship between male overactive bladder (OAB) symptoms and androgen deprivation revealed that ADT in patients with PCa was associated with an increased risk of OAB that was ADT duration-dependent 23 . Taken together, considering that the changes in both PV and testosterone during ADT can affect LUTS, analyzing that the combined effect of the two may provide relevant suggestions to enlighten the actual cause of changes in LUTS in patients with PCa undergoing ADT.…”

Clinical Significance of Prostate Volume and Testosterone Reduction on Lower Urinary Tract Symptoms in Patients with Prostate Cancer Undergoing Androgen Deprivation Therapy

“…Especially, lower IPSS-ss were reported in patients with testosterone supplementation than control by a more recent study based on a large registry data [2122]. In the same context, an Asian study that investigated the relationship between male overactive bladder (OAB) symptoms and androgen deprivation revealed that ADT in patients with PCa was associated with an increased risk of OAB that was ADT duration-dependent [22]. Taken together, considering that the changes in both PV and testosterone during ADT can affect LUTS, analyzing that the combined effect of the two may provide relevant suggestions to enlighten the actual cause of changes in LUTS in patients with PCa undergoing ADT.…”

What was hot at ICS 2016?

“…Unusually strong longitudinal cohort studies of incontinence were presented. Using a sample of 16 128 women in the Taiwanese National Health Insurance Research Database, small but statistically significant excess risks of LUTS were shown after a breast cancer diagnosis, most likely associated with oestrogen deprivation therapy (Abstract 208). Using a sample of 2115 women enrolled in the French GAZEL cohort, between 2000 and 2008, a positive benefit of incontinence surgery for severe stress incontinence was observed, but offset against an increased risk of mixed or urgency incontinence, consistent with our understanding of the risks of midurethral sling surgery (Abstract 209).…”