To determine the effects of reversible medical
castration on prostatic size and symptoms we treated 15 patients with
benign prostatic hypertrophy with a long-acting
GnRH analog,
leuprolide (1 mg/day sc), for a minimum of 4 months. The men's serum
testosterone,
dihydrotestosterone, and
estradiol concentrations fell to very low levels within 4-6 weeks after the initiation of treatment. Transrectal ultrasonography of the prostate demonstrated an average shrinkage of 40% after 4 months of treatment (n = 15) and 46% after 6 months of treatment (n = 11). All 15 men had improvement in urinary flow and, to a lesser extent, in
nocturia and frequency. The side-effects of the
therapy were decreased potency and
flushing. The most dramatic improvement occurred in 4 of the 5 men who had complete urinary obstruction before treatment. One man had a suprapubic
cystotomy tube removed during the fifth treatment month. Two other men who had Foley
catheters before treatment are voiding well without
catheters since their third treatment month. Another man who had a very large prostate (300 g) before treatment had one successful voiding trial, although he still has a suprapubic
cystotomy tube. One man decided to stop treatment after 6 months. Two months later his
hormone values and prostate size had returned to pretreatment levels. One man treated during the fourth and fifth months with
fluoxymesterone in addition to
leuprolide had regrowth of his prostate while receiving this
androgen. We conclude that
leuprolide treatment of men with
benign prostatic hypertrophy results in shrinkage of prostatic size and concomitant improvement in the obstructive symptoms of
prostatism. The prostatic shrinkage reverses when treatment is discontinued or combined with
androgen.