OBJECTIVE: To evaluate the frequency of bladder outlet obstruction (BOO) and detrusor overactivity (DO) in patients with castration-resistant prostate cancer (CRPC) and lower urinary tract symptoms (LUTS).
PATIENTS AND METHODS: Our prospective urodynamics database was studied. Inclusion criteria were CRPC and an International Prostate Symptom Score (IPSS) ≥20. Exclusion criteria were previous local therapy to the prostate gland, known urethral stricture disease, and a neurological component of LUTS. Twenty-one patients were identified. Urodynamic findings were analysed and compared with those of a matched cohort of 42 patients with benign prostatic enlargement (BPE).
RESULTS: Median age of patients with CRPC was 74 years, and the median prostate-specific antigen (PSA) level at the time of the urodynamic study was 90 ng/ml. According to the BOO Index, 3 patients (14%) were obstructed, 3 were equivocally obstructed (14%) and 15 were unobstructed. DO was seen in 12 patients (57%). Compared with BPE patients, those with CRPC had lower cystometric bladder capacities (p=0.003), were less likely to have BOO (14% vs 43%, p=0.009) and more likely to have DO (57% vs 29%, p=0.028).
CONCLUSIONS: This study generates the hypothesis that only a minority of CRPC patients with LUTS have BOO, and that more than half of patients have DO. The data suggest that LUTS in CRPC may be seldom due to BOO, but (at least in part) related to DO and the reduced cystometric capacity. An urodynamic investigation may be necessary before palliative TURP to select appropriate candidates. Larger prospective studies are needed to confirm our findings.
Written by:
Rom M, Waldert M, Schatzl G, Swietek N, Shariat SF, Klatte T. Are you the author?
Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
Reference: BJU Int. 2013 Sep 5. Epub ahead of print.
doi: 10.1111/bju.12438
PubMed Abstract
PMID: 24053594
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