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Hormonal treatment of obstructed kidneys in patients with prostatic cancer
M Honnens de Lichtenberg1, J Miskowiak, H Rolff
1Department of Urology, Bispebjerg Hospital, Copenhagen, Denmark.
Abstract:
A review of 1288 patients with previously untreated prostatic cancer revealed 209 patients (16%) with ureteric obstruction; the obstruction was bilateral in 36%. The effect of hormonal treatment was assessed in 88 patients with 120 obstructed kidneys: 77 patients had androgen deprivation or hormonal medication alone and 11 patients needed percutaneous nephrostomy or ureteric catheters in addition. Drainage improved in 58% of the kidneys. The diverting catheter was withdrawn in 9 of the 11 patients after a median of 4 weeks. In all, 95% of patients were discharged. The patients with hormonal therapy alone survived for a median of 26 months (range 1-111), while the patients who also needed diversion survived for a median of 13 months (range 1-28). The median time spent at home was 24 months (0-102) and 10 months (0-23) respectively, presumably reflecting the worse general condition of the patients who required diversion.
Insights
Hormonal therapy can help manage ureteric obstruction in prostate cancer patients, with 58% of kidneys showing improved drainage. Those needing additional diversion had shorter survival times, highlighting the importance of effective treatment strategies.
Area of Science:
- Urology
- Oncology
Background:
- Ureteric obstruction is a significant complication in advanced prostate cancer.
- 16% of previously untreated patients in this review experienced ureteric obstruction.
Purpose of the Study:
- To evaluate the effectiveness of hormonal treatment for ureteric obstruction in prostate cancer.
- To assess the impact of additional urinary diversion on patient outcomes.
Main Methods:
- Retrospective review of 1288 patients with untreated prostate cancer.
- Analysis of 88 patients with 120 obstructed kidneys treated with hormonal therapy +/- diversion.
- Assessment of drainage improvement, catheter withdrawal, survival, and time spent at home.
Main Results:
- Hormonal treatment alone or with diversion improved drainage in 58% of obstructed kidneys.
- 95% of patients were discharged, with diverting catheters withdrawn in most cases.
- Patients receiving hormonal therapy alone had a median survival of 26 months, compared to 13 months for those also requiring diversion.
Conclusions:
- Hormonal therapy is a viable option for managing ureteric obstruction in prostate cancer.
- The need for urinary diversion may indicate a poorer prognosis and warrants further investigation.
- Optimizing treatment for ureteric obstruction can improve patient quality of life and potentially survival outcomes.