Can androgen-deprivation therapy obviate the need of channel transurethral resection of the prostate in advanced prostate cancer with urinary retention? A prospective study

Abstract

ObjectiveTo evaluate the efficacy of androgen-deprivation therapy (ADT) in relieving urinary retention in patients with advanced prostate cancer presenting with urinary retention or a high post-void residual urine volume (PVR).Patients and methodsPatients with advanced prostate cancer with an indwelling catheter for acute/chronic urinary retention, or with a high PVR (>200 mL) who had not received any previous treatment were included in the study. Patients with localised prostate cancer eligible for receiving any therapy aimed at cure were excluded. All enrolled patients were managed by ADT (LHRH antagonist/agonist or orchidectomy) combined with α-adrenoceptor antagonist/combined therapy for at least 1 month to a maximum of 3 months; they were given their first trial of voiding without catheter after 1 month, and monthly thereafter.ResultsA total of 101 patients received ADT of which 97 were able to void successfully at the end of 3 months. In all, 27 patients could void in the first month, followed by 50 in the second month, and an additional 20 in the third month. There was a significant decrease in prostate volume, PVR, and International Prostate Symptom Score, and maximum urinary flow rates improved with normalisation of renal functions and resolution of upper tract changes noted on ultrasonography.ConclusionADT can relieve retention and decrease PVR over a period of time obviating the need for channel transurethral resection of the prostate.

Clinical and Histopathological Characteristics of Prostate Cancer Patients Taken to Palliative Transurethral Prostate Resection

“…Conversely, a recently published study of metastatic PCa patients found that performing palliative TURP in addition to administering ADT, could significantly improve cancer-specific survival (CSS) compared with patients who only received ADT, when PSA ≥65 ng/ml, GS ≥8, and bone metastases ≤5 [13]. Although palliative TURP is the treatment of choice in patients with LUTS and PCa, only ADT can relief retention and decrease post voiding residual urine volume over a period of time, and can obviate the need for channel TURP in some patients [14].…”