Premium
Bladder outlet obstruction ( BOO ) in men with castration‐resistant prostate cancer
Author(s) -
Rom Maximilian,
Waldert Matthias,
Schatzl Georg,
Swietek Natalia,
Shariat Shahrokh F.,
Klatte Tobias
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12438
Subject(s) - medicine , lower urinary tract symptoms , bladder outlet obstruction , urology , prostate cancer , prostate , cancer
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 queried. Inclusion criteria were CRPC and an I nternational P rostate S ymptom S core ( 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 The median age of patients in the CRPC group 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, three patients (14%) were obstructed, three were equivocally obstructed (14%) and 15 were unobstructed. DO was seen in 12 patients (57%). Compared with the BPE group, patients 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 . LUTS in CRPC may therefore be seldom attributable to BOO, but are, at least in part, related to DO and reduced cystometric capacity. A urodynamic investigation may be necessary before palliative transurethral resection of the prostate to select appropriate candidates. Larger prospective studies are needed to confirm our findings.