Testosterone, prostate volume influence lower urinary tract symptoms in prostate cancer

Among prostate cancer patients on androgen deprivation therapy (ADT), a small prostate and higher reductions in testosterone levels appear to aggravate storage symptoms, a recent study has found.

Researchers conducted a retrospective analysis of 167 patients, in whom the International Prostate Symptom Score (IPSS) was assessed every four weeks for up to 12 weeks after ADT initiation. Prostate volume and testosterone levels were also included in the analyses.

Relief from lower urinary tract symptoms (LUTS) was significantly more common in men with large vs small prostates at week 8 (prostate volume <33 vs ≥33 mL; 40.7 percent vs 30.9 percent, respectively; p=0.021). Such an effect was persistent until week 12, when 43.0 percent of men with large prostates showed treatment response, as opposed to only 34.6 percent of the small-prostate subgroup (p=0.036).

Moreover, mean IPSS scores decreased across all patients from baseline to 12 weeks. This was true for the total, voiding subscale, and storage subscale scores, and was significant for men with small (r, –0.563, –0.485, and –0.232, respectively; p<0.05 for all) and large (r, –0.759, –0.626, and –0.357, respectively; p<0.05 for all) prostate volumes.

Of note, however, when focusing on those with total IPSS score ≥13, the researchers found that scores in the storage subscale of the IPSS were virtually unchanged in men with small prostates (p=0.179). Moreover, storage scores increased by an average of 0.08 points in men with small prostate and large reductions in testosterone levels.

“LUTS generally improves in patients with prostate cancer undergoing ADT,” the researchers said. “However, in patients with clinically meaningful symptoms, storage symptom did not improve significantly in those with small prostate. Storage symptoms even worsened in patients with both small prostate and greatest testosterone reduction.”