雄性素剝奪治療對攝護腺癌患者夜間多尿與下泌尿道症狀之影響

陳米妮¹、林志杰^1,2,3、黃逸修^1,2,3

¹台北榮民總醫院 泌尿部；²陽明大學醫學院泌尿學科；³書田泌尿學研究中心

Impact of androgen deprivation therapy (ADT) on nocturnal polyuria and lower urinary tract symptoms in patients with prostate cancer

Minnie Chen¹, Chih-Chieh Lin^1,2,3, Eric Yi-Hsiu Huang^1,2,3

¹Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan

²Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan

³Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan

Introduction & Objectives:

Lower urinary tract symptoms (LUTS) and nocturia are common in prostate cancer. Androgen deprivation therapy (ADT) may relieve bladder outlet obstruction, but its effect on nocturnal urine production is uncertain. This study evaluated changes in nocturnal polyuria (NP) and LUTS before and after ADT.

Methods:

We retrospectively reviewed 62 patients with prostate cancer treated with ADT and no prior lower urinary tract surgery. PSA, testosterone, International Prostate Symptom Score (IPSS), and voiding diaries were assessed before ADT and after testosterone declined to castration levels. Voiding diary outcomes were total urine volume, nocturnal urine volume, and nocturnal polyuria index (NPI); nocturnal polyuria was defined as NPI >33%. Patients were stratified by baseline NPI into NP and non-NP groups. Paired analyses were performed in patients with complete data.

Results:

The mean age was 75.5 years. Fifty patients had paired voiding diaries and 46 had paired IPSS data. ADT did not change total urine volume (Δmean 26.8 mL, p = 0.7985). Nocturnal urine volume increased modestly overall (Δmean 83.0 mL, p = 0.0994), and the overall change in NPI was not significant (Δmean 0.0258, p = 0.1848). In the NP group (n = 29), nocturnal urine volume remained stable, whereas NPI decreased slightly (Δmean −0.0474, p = 0.0252). In the non-NP group (n = 21), nocturnal urine volume (Δmean 218.4 mL, p = 0.0047) and NPI (Δmean 0.1269, p < 0.001) increased significantly; 13 of 21 patients developed nocturnal polyuria after ADT. Storage symptoms did not change significantly (Δmean −0.20 ± 3.07, p = 0.661), whereas voiding symptoms (Δmean −3.32 ± 6.49, p = 0.0015) and total IPSS (Δmean −3.52 ± 8.63, p = 0.0096) improved significantly. Patients with severe baseline LUTS had the greatest reduction in voiding scores (Δmean −9.86 ± 4.17, p < 0.0001).

Conclusions:

ADT improves voiding symptoms, especially in patients with severe baseline LUTS, but does not reduce nocturnal polyuria overall. Patients without baseline nocturnal polyuria may develop increased nocturnal urine production after ADT, suggesting that nocturia related to nocturnal polyuria may persist despite improved voiding symptoms.