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J Urol. 2010 Feb;183(2):634-9. doi: 10.1016/j.juro.2009.09.084. Epub 2009 Dec 16.

Does neoadjuvant hormonal therapy improve urinary function when given to men with large prostates undergoing prostate brachytherapy?

Author information

1
Departments of Urology, Mount Sinai School of Medicine, New York, New York, USA. nelsonstone@optonline.net

Abstract

PURPOSE:

We evaluated the effect of neoadjuvant hormonal therapy on urinary function in men with a prostate volume of 50 cc or greater undergoing prostate brachytherapy.

MATERIALS AND METHODS:

A total of 395 men with 50 cc or greater glands were treated with 3 months of neoadjuvant hormonal therapy (204) or implantation alone (191). Urinary function was assessed by the International Prostate Symptom Score, the urinary retention incidence and subsequent transurethral prostate resection.

RESULTS:

Median patient age was 67 years and median followup was 6 years. Mean prostate volume in neoadjuvant hormonal therapy cases was 72.9 cc, which decreased to 54.3 cc after 3 months (p <0.001). Mean prostate volume in cases without hormonal therapy was 60.6 cc (p <0.001). Urinary retention occurred in 16 of 191 men (8.4%) without vs 25 of 204 (12.3%) with hormonal therapy (p = 0.207). The median duration of urinary retention was 42 days (range 2 to 243). There were no significant associations of urinary retention with prostate size, prostate or urethral dose, or pre-implantation International Prostate Symptom Score. Of patients without hormonal therapy retention occurred in 3 of 12 (25%) with a pre-implantation International Prostate Symptom Score of 15 or greater and in 13 of 168 (7.7%) with a score of less than 15 (OR 4.0, 95% CI 1-16, p = 0.04). In contrast, there was no difference in the retention rate in patients with hormonal therapy with an initial score of 15 or greater vs less than 15 (2 of 25 or 8% vs 11 of 102 or 10.8%, p = 0.614). Transurethral prostate resection was done in 11 of 191 men (5.8%) without vs 12 of 204 (5.9%) with hormonal therapy (p = 0.958). There was no difference in biochemical failure in the 2 groups.

CONCLUSIONS:

Neoadjuvant hormonal therapy has its greatest benefit in patients receiving brachytherapy who have a large prostate and an International Prostate Symptom Score of 15 or greater.

Comment in

PMID:
20018308
DOI:
10.1016/j.juro.2009.09.084
[Indexed for MEDLINE]

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