Lower urinary tract symptoms (LUTS) and nocturia frequently affect patients with prostate cancer. Androgen deprivation therapy (ADT) is known to reduce prostate size and may alleviate bladder outlet obstruction, leading to improvement in voiding symptoms. However, its influence on nocturnal urine production remains uncertain. This study aimed to assess changes in nocturnal polyuria (NP) and LUTS after ADT and to examine whether outcomes differ according to baseline NP status.

We conducted a retrospective analysis of 62 patients with prostate cancer who received ADT and had no history of lower urinary tract surgery. PSA, testosterone levels, International Prostate Symptom Score (IPSS), and 24-hour voiding diaries were assessed before ADT and after achieving castration-level testosterone. Voiding diary variables included total urine volume, nocturnal urine volume, and nocturnal polyuria index (NPI), with NP defined as NPI >33%. Patients were categorized into NP and non-NP groups based on baseline NPI. Paired comparisons were performed in patients with complete voiding diary and IPSS data.

The mean age of the cohort was 75.5 years. Paired voiding diary data were available for 50 patients, and 46 patients had paired IPSS data. Total urine volume remained unchanged after ADT (Δmean 26.8 mL, p = 0.7985). Nocturnal urine volume showed a modest increase (Δmean 83.0 mL, p = 0.0994), and the change in NPI was not statistically significant (Δmean 0.0258, p = 0.1848).

In subgroup analysis, patients with baseline NP (n = 29) had stable nocturnal urine volume, with a slight reduction in NPI (Δmean −0.0474, p = 0.0252). In contrast, those without baseline NP (n = 21) demonstrated significant increases in both nocturnal urine volume (Δmean 218.4 mL, p = 0.0047) and NPI (Δmean 0.1269, p < 0.001), with 13 patients developing NP after treatment.

With respect to LUTS, storage symptom scores did not change significantly (Δmean −0.20 ± 3.07, p = 0.661). In contrast, voiding symptoms (Δmean −3.32 ± 6.49, p = 0.0015) and total IPSS (Δmean −3.52 ± 8.63, p = 0.0096) showed significant improvement. The greatest reduction in voiding symptom scores was observed in patients with more severe baseline LUTS (Δmean −9.86 ± 4.17, p < 0.0001).

ADT was associated with improvement in voiding symptoms, consistent with reduced bladder outlet obstruction. However, nocturnal urine production did not decrease overall and increased significantly in patients without baseline NP. These findings suggest that the mechanisms underlying nocturnal urine production may differ from those responsible for voiding symptoms, and that ADT may alter urine distribution patterns without reducing total urine output.

ADT is associated with improvement in voiding symptoms but does not reduce nocturnal polyuria. Patients without baseline NP may develop increased nocturnal urine production after treatment. Persistent nocturia after ADT warrants evaluation for nocturnal polyuria rather than residual obstruction.

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Continence 19S (2026) 102746
DOI: 10.1016/j.cont.2026.102746