The effect of neoadjuvant androgen deprivation therapy for prostate cancer on lower urinary tract symptoms: Could they be affected by prostate gland volume reduction?

Abstract

<p>Neo-adjuvant androgen deprivation therapy (NADT) is commonly undertaken for 3-6 months prior to radiotherapy for prostate cancer and causes shrinkage of the prostate gland. The changes in lower urinary tract symptoms and their relationship with the changes in the prostate gland volume as it shrinks have not been studied in detail. Urinary symptoms prior to radiotherapy predict for urinary problems during and after radiotherapy and reductions in them might reduce the risk of these occurring. Fifty consecutive patients with intermediate and high-risk prostate cancer were treated with six months of triptorelin prior to definitive radiotherapy. Urinary symptoms were measured using international prostate symptom scoring system (IPSS) scores. The volume of the prostate gland was measured using serial magnetic resonance imaging (MRI) scans. Volumes and symptoms were measured at the outset and every six weeks during the neoadjuvant component of the treatment. The mean IPSS score at the outset was 11.76 and reduced by a mean of 1.67 over the six-month period. Although the median prostate volume reduced over that time, there was no significant correlation between them, or between the IPSS and changes in prostate-specific antigen (PSA) or testosterone levels. Urinary symptoms were relatively stable during the treatment and were not associated with changes in the prostate gland volume. When those patients with more severe IPSS than the mean value were considered separately, an improvement by 5.31 points was noted. Neoadjuvant hormone therapy is unlikely to affect the ability of patients to complete their radiotherapy with any lowering of their risk of treatment interruption due to urinary toxicity or their risk of long-term urinary problems, unless they have relatively severe symptoms initially.</p>