男性荷爾蒙去除治療對於攝護腺癌病人下泌尿道症狀的影響—臺北榮總經驗

陳鵬¹、黃逸修^1,2、張延驊^1,2、鍾孝仁^1,2、黃子豪^1,2、陳威任^1,2、林志杰^1,2、郭俊逸^1,2、

黃奕燊^1,2、魏子鈞^1,2、林登龍^1,2、林子平^1,2、范玉華^1,2、黃志賢^1,2

¹臺北榮民總醫院 泌尿部；

²國立陽明交通大學醫學院泌尿學科 書田泌尿科學研究中心

The impact of androgen deprivation therapy on lower urinary tract symptoms in prostate cancer patients - a single institute experience

Peng Chen¹, Eric Yi-Hsiu Huang^1,2, Yen-Hwa Chang^1,2, Hsiao-Jen Chung^1,2, Tzu-Hao Huang^1,2,

Wei-Ren Chen^1,2, Chi-Cheh Lin^1,2, Junne-Yih Kuo^1,2, I-shen Huang^1,2, Tzu-Chun Wei^1,2, Alex T.L. Lin^1,2, Tzu-Ping Lin^1,2, Yu-Hua Fan^1,2, William J. Huang^1,2

¹ Department of Urology, Taipei Veterans General Hospital;

² Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

Purpose

Androgen deprivation therapy (ADT) has been well recognized as the cornerstone therapy for prostate cancer (PCa) patients across all risk groups. The lower urinary tract symptoms (LUTS) of advanced PCa patients may be contributed by both benign prostatic hyperplasia and the tumor. Therefore, ADT will impact the LUTS in patients with PCa. Moreover, some patients with advanced disease may accept concurrent ADT and radiation therapy (RT) which will probably further influence the LUTS. Hence, we aimed to analyze the effects of ADT on LUTS in patients with advanced PCa.

Materials and Methods

Patients diagnosed with PCa using ADT were enrolled prospectively. Those who received any prostate or urethra related surgery (transurethral resection of the prostate, radical prostatectomy, urethrotomy), bladder or urethra botulinum toxin injection, using 5-alpha reductase inhibitor and under Foley insertion were excluded. Patients with locally advanced PCa managed with concurrent ADT and RT were also enrolled. PSA and IPSS questionnaire were measured every 3 months. Transabdominal ultrasound and uroflowmetry (UFR) was performed at initial survey, 6-month, and 12-month follow up. Both descriptive and comparative statistical analyses were performed. The functional parameters between ADT alone and concurrent ADT+RT were compared using a repeated measures analysis of covariance (ANCOVA) model.

Results

45 patients were included with the mean age of 73.1±9.7 years. Twenty-one (46.7%) of them were metastatic disease, 21 (46.7%) were locally advanced, and 3 (6.6%) were localized disease. Seventeen patients (37.8%) were managed with concurrent ADT and RT. For the whole group, initial prostate volume was 55.27±31.55ml, IPSS was 14.31±7.56, maximal uroflow rate was 9.82±4.29 ml/sec, and mean uroflow rate was 4.64±2.53 ml/sec. At 3-month follow up, IPSS was 11.56±6.79 which was significantly lower than initial IPSS. At 6-month follow up, prostate volume, IPSS, and uroflow rate were also significantly improved than initial parameters. However, there were no significant differences for IPSS and uroflow rate at 9-month and 12-month follow up. In addition, there were no significant differences between patients who receiving ADT alone and ADT+RT in terms of IPSS, prostate volume, uroflow rate during follow up.

Conclusions

For PCa patients, ADT ameliorate LUTS significantly in both subjective and objective outcomes especially in the first 6 months. RT add on to ADT seemed not to influence the LUTS compared to those who accepted ADT alone.