Effect of endocrine treatment on voiding and prostate size in men with prostate cancer: a long-term prospective study.

OBJECTIVE: The aim of this study was to assess and quantify changes in voiding parameters and prostate size in men with prostate cancer from before the start of endocrine treatment and during long-term follow-up.

MATERIAL AND METHODS: Seventy-seven patients were recruited from three clinics and followed prospectively until death, clinical deterioration making the patient unfit for participation, or the end of the study. Median age was 74 (range 54-85) years, and the median follow-up was 18 (3-90) months. Parameters and endpoints were total score on the Danish Prostatic Symptom Score (DAN-PSS-1) questionnaire, maximum flow rate, postvoid residual volume, frequency and voided volume, and prostate volume on transrectal ultrasonography.

RESULTS: All parameters improved significantly in the range of median 13-50% within the first 12 months. The greater part of the effect occurred during the first month, and thereafter the improvement rate slowed down. Intervention for local progression was estimated on Kaplan-Meier analysis to be about 20% after 4 years. 73% had a defined prostate-specific antigen nadir after a median of 6 (1-60) months with scheduled assessments up to 72 months after the nadir. All parameters were improved before the nadir and the improvement remained during biochemical progression except for the very latest visits where few patients contributed to the analyses.

CONCLUSIONS: Androgen deprivation therapy improved lower urinary tract symptoms, objective voiding parameters and prostate volume in patients with prostate cancer who were not candidates for curative treatment. The improvement was significant within the first month and clinically relevant. Despite biochemical progression the effect may last for years, and only a minority will need intervention for local progression.