分析睪固酮濃度對男性荷爾蒙去除治療在攝護腺癌病人夜尿症狀的影響

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

黃奕燊^1,2、魏子鈞^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及書田泌尿科學研究中心

Analyzing the effects of testosterone level on nocturia in prostate cancer patients receiving androgen deprivation therapy

Peng Chen¹, Chih-Chieh Lin^1,2, Yen-Hwa Chang^1,2, Hsiao-Jen Chung^1,2, Eric Yi-Hsiu Huang^1,2,

Tzu-Hao Huang^1,2, Wei-Ren Chen^1,2, I-shen Huang^1,2, Tzu-Chun Wei^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, School of Medicine, College of Medicine, 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. In patients receive ADT, testosterone level will decrease to castration level, which may lead to worsening nocturia symptom. Hence, we aimed to analyze the effects of ADT on nocturia in patients with PCa.

Materials and Methods

Patients were enrolled prospectively after being proved with the diagnosis of advanced PCa. Those who received any prostate or urethra related surgery (transurethral resection of the prostate, radical prostatectomy, urethrotomy), bladder or urethra botulinum toxin injection, under Foley insertion were excluded. Before receiving hormone therapy, like ADT, all patients were asked to record voiding diary for 3 consecutive days. PSA and testosterone level were measured before and after hormone treatment, and then 3 monthly. Voiding diary was collected again for 3 consecutive days at the time of achieving castration level by checking testosterone level (under 0.5 ng/ml). Both descriptive and comparative statistical analyses were performed.

Results

Overall, 30 patients were included with the mean age of 74.73±11.04 years old (ranging from 55 to 101). For the whole group, initial prostate volume was 48.27±30.89ml, IPSS was 11.83±8.08, and testosterone level was 3.66±1.44 ng/ml. At 3-month follow up, IPSS was 11±7.54, with testosterone level decreased to 0.06±0.05 ng/ml .Comparing the data of pre-castration and post castration phase, the 24-hour voided volume (1989.94±719.38ml vs. 1906.04±739.37ml), total voiding times (12.18±3.67 vs. 11.27±4.06), nocturnal voiding times (3.31±1.81 vs. 3.21±1.92) showed no statistical difference. However, the difference between nocturnal urine volume (660.78±329.76ml vs. 745.22±329.67ml; p=0.042) and nocturnal polyuria index (34.43±14.58% vs. 39.31±9.4%; p=0.003) was significant.

Conclusions

In our cohort, testosterone level greatly decreased to castration level after ADT administration on prostate cancer patients. Increasing trend of nocturnal urine volume and nocturnal polyuria was observed by self-recorded voiding diary.