2005, Number 5
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Rev Mex Urol 2005; 65 (5)
Acute urinary retention: Maximal androgen blockade response
Juárez AAC, Delgado EI
Language: Spanish
References: 32
Page: 312-321
PDF size: 79.89 Kb.
ABSTRACT
Introduction. One of the principal clinical manifestation of advanced prostate cancer (CaP) is the acute urinary retention (AUR). Transurethral prostatic resection (TURP) has been the initial step in its management, but this procedure give more risk than in benign prostatic hyperplasia. Maximal androgen blockade (MAB) with bilateral orquiectomy and the addition of one nonsteroidal antiandrogen is recognised that reduced the prostate volume and give one comfortable micturition, but is underused.
Objectives. Recognized that the micturition can be re-established in few months, in patients advanced CaP and AUR secondary, managed with MAB, and this don’t make necessary TURP like initial management.
Methods. Between 1992 and 2002, ten patients with AUR were diagnosed with digital rectal examination (DRE), prostatic specific antigen (PSA) and randomised transrectal biopsy with tru cut needle, like advanced stage of CaP, and where managed with Foley cateter and MAB-bilateral orchiectomy + flutamide 750 mg by day.
Results. The median follow-up time was 24 months. The micturition was re-established in the 10 patients at the 57 day with rank of 30-90 and ED ± 16.1, the age of the patients was 72.2 with rank between 62-84 ED ± 7.6 years, the Gleason score was of 6 with rank of 3-8, the APE initial was 111.4 ng/mL with rank of 15-200, and 3 months after was of 3.5 with rank of 0.03-20.5 ng/mL p ‹ 0000. The prostate volume at the beginning was of 46 g with rank 30-60 ED ± 8.76, and 3 months latter reduced at 27 g with rank of 20-40 ED ± 50-30% p ‹ 0000. The initial performance and satisfaction with the micturition, in the observation period was of 3.3 X with rank of XX to XXXX. Six patients developed disease progression, four died before of 13.5 months, nobody required TURP.
Conclusions. With the MAB + uretrovesical Foley catheter our patients achieve micturition in a time of two and maximal 3 months at late, and we think that the procedure employed is as effective and more safe than TURP, this late procedure must be employed only if the MAB failed.
REFERENCES
Moul JW, Davis R, Vaccaro JA, Velville WD, McLeod DG. Acute urinary retention associated with prostatic carcinoma. J Urol 1989; 141: 1375-7.
Pickard R, Emberton M, Neal DE. National Prostatectomy Audit Steering Group. The management of men with acute urinary retention. BJU 1998; 81(5): 712-20.
Liapis D, Doumas K, Aristas O, Fraogoulis D, Liakatas I. Acute urinary retention and prostate cancer: invasive vs. non invasive approach. BJU International 2002; 90(Suppl. 2): 166.
Jimenez RMA. Simposium sobre cáncer metastásico de la próstata. Reunión Regional de Urología Centro-Occidente, Guadalajara, Jalisco, México. Agosto 27-28, 2004.
Thompson IM, Troyer D. Escrutinio en el cáncer de próstata. En: Teichman JMH (ed.). 20 problemas comunes en urología. 1a. Ed. México: Manual Moderno; 2003, p. 147-62.
Pow-Sang GM, Corrales VB, Morantre DC, Meza ML, Olaechea MC. Diagnóstico del cáncer de próstata mediante tacto rectal, antígeno prostático específico y biopsia transrectal por ultrasonografía en el Instituto de Enfermedades Neoplásicas (Lima-Perú). Rev Urol Panamer 2001; 15(1): 1-6.
Murthy GD, Byron DP, Pascuale DC. Underutilization of digital rectal examination when screening for prostate cancer. Arch Intern Med 2004; 164(3): 313-6.
Klots L. Therapeutic options for advanced prostate cancer, AUA Instructional Course 2004. In: Management of advanced prostate cancer, AUA’04 San Francisco annual meeting (EUA), may 8-13, 2004.
Blandy JP. Carcinoma and other disorders of the prostate, in transurethral resection, 1a. Ed. Chapt. 8. London: Edit. University Park-Press; 1971, p. 113-22.
10.Mazur A, Thompson I. Efficacy and morbidity of “channel” TURP. Urology 1991; 38: 526.
11.Smith JA, Soloway MS, Young MJ. Complications of advanced prostate cancer. Urology 1999; 54(Suppl. 6A): 8-18.
12.Donald SC, Cristopher LA, Cristopher JK. Palliative transurethral prostate resection for bladder outlet obstruction in patients with locally advanced prostate cancer. J Urol 2004; 171(2): 668-71.
13.Gil-Sanz MAJ. Supresión andrógena en cáncer de próstata ¿Tratamiento paliativo? (Editorial). Actas Urol Esp 2003; 26(1): 79-83.
14.Miyamoto H, Messing EM. Early versus late hormonal therapy for prostate cancer. Current Prostate Reports 2004; 2: 60-8.
15.Kirby RS, Christmas TJ, Brawer M. Imaging and staging of prostate cancer. Prostate Cancer. 1a. Ed. Chapt 8. Italy: Ed. Mosby; 1996, p. 77-92, and appendix p. 167.
16.Loblaw DA, Mendelson DSS, Talcott JA, Virgo KS, Somerfield MR, Ben JE, Middleton R, Porterfield H, Sharp SA, Smith TJ, Taplin ME, Vogezlang NJ, Wade JL, Bennet CL, Scher HI. American Society of Clinical Oncology. Recommendations for the initial Hormonal Management of Androgen Sensitive Metastatic, Recurrent, or Progressive Prostate Cancer (ASCO Special Article). J Clin Oncol 2004; 22(14); 2997-41.
17.Klotz L, Shcellhammer P, Carroll K. A re-assessment of the role of combined androgen blockade for advanced prostate cancer (mini reviews). BJU International 2004; 93(9): 1177-82.
18.De Paula A, Piccelli H, Pinto N, et al. Impacto económico de la orquiectomía en el cáncer prostático avanzado. Inter Braz J Urol 2003; 29(2): 127-32.
19.Garnik MB. Prostate cancer: screening, diagnosis and management. Ann Intern Med 1993; 118(10): 804-18.
20.Anson KM, Barnes DG, Briggs TP, Watson GM, Miller RA. Temporary prostatic stenting and androgen suppression; a new minimally invasive approach to malignant prostatic retention. JR Soc Med 1993; 86: 634-6.
21.Thomas DJ, Balaji VJ, Coptcoat MJ, Abercrombie GF. Acute urinary retention secondary to carcinoma of the prostate. Is initial channel TURP beneficial? JR Soc Med 1992; 85(6): 318-9.
22.Mommsen S, Petersen L. Transurethral catheter removal after bilateral orchiectomy for prostatic carcinoma associated with acute urinary retention. Scand J Urol Nephrol 1994; 28(4): 401-4.
23.Serrano BEA, Lorenzo-Monterrubio JL, Ramirez MA, Cedillo LU, Wingartz PHF, Moreno AJ. Impacto de la deprivación androgénica total en los pacientes con obstrucción a la salida de la vejiga por cáncer de próstata avanzado. Bol Col Mex Urol 1997; 14(2): 104-8.
24.Moreira IO, Goldemberg LS. Tratamiento hormonal del cáncer de próstata avanzado. Rev Urol Panam 2000; 12(1): 1-8.
25.Steiner JI, Rosenblum M, Crawford DE. Treatment of advanced (Stage T1-4NxM+) Prostate cancer. In: Lepor H (ed.). Prostatic Diseases. 1a. Ed. Chapt 41. USA: WB Saunders Co.; 2000, p. 509-22.
26.Kirby RS, Christmas TJ, Brawer M. Tumors markers in prostate cancer. In: Prostate cancer. 1a. Ed. Chapt. 6. Italy: Ed Mosby; 1996, p. 55-64.
27.Tangen C, Crawford ED, Faulkner J, Thompson I, Eisenberger M, Ussain M. Ten year survival in patients with metastatic (M+) prostate cancer (CaP): analisis of southwest oncology group (SUOG) 8,849. In: Cancer abstracts and summaries. Ed. Physicians’ Education Resourese, Dallas Tx (USA), and Aventis Oncology.
28.El Wkhi BM. Late presentation of prostatic carcinoma. BJU International 2002; 90(Suppl. 2): 162.
29.Hass CA, Resnick MI. Imaging of the prostate. In: Lepor H (ed.). Prostatic diseases. 1a. Ed. Chapt. 6. USA: WB Saunders; 2000, p. 75-93.
30.Williams G. Other assessments: prostate size and prostate specific antigen. BJU International 2000; 85(Suppl. 1): 31-5.
31.Smith JA, Scardino PT, Resnick MI, Hernández AD, Rose SC. Egger MJ. Transrectal ultrasound versus digital rectal examination for the staging of carcinoma of the prostate: results of a prospective, multi-institutional trial. J Urol 1997; 157(3): 902-6.
32.McMurtry CT, McMurtry JM. Metastatic prostate cancer: complications and treatment. J Am Geriatr Soc 2003; 51(8): 1136-42.
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