Approach to urinary obstruction in the diagnosis and follow-up of prostate cancer

In this study, the relationship between obstructive uropathy (OU) detected patients with advanced prostate cancer and patient age, renal function, urinary infection rate, prostate specific antigen (PSA) value, stage, response and resistance to cancer treatment, rate of need for further cancer treatments, and OU treatments has been researched. The study was conducted with newly diagnosed metastatic prostate cancer patients who applied to Manisa Celal Bayar University Urology Department between January 2017 and March 2021. 48 of these patients, who were eligible to receive hormonal therapy and docetaxel chemotherapy together, were included in the study in line with the current guideline recommendations. Of the 48 patients, 19 patients were found to have hydronephrosis. While 11 patients had hydronephrosis diagnosed at the time of diagnosis, 8 patients had hydronephrosis during follow-up. According to our study, the presence of hydronephrosis in the patient is in a statistically significant relationship with elevated creatinine at the time of diagnosis, increased creatinine in the follow up, urinary tract infection proven by culture antibiogram at the time of diagnosis and during follow-up, development of castration resistance in the follow-up of treatment and high PSA values at the time of diagnosis (Hydronephrosis at diagnosis). It was observed that most patients (78%) were treated with nephrostomy and anterograde stent or retrograde stent. As result, kidney functions should be observed very carefully in patients who develop or are at risk of developing OU and minimally invasive procedures should be preferred and timed correctly. Physicians should be very careful against urinary infections. The development of high PSA values and/or castration resistance should be approached carefully in terms of the patient's prognosis, it should not be forgotten that their significant relationship with OU has been demonstrated. Considering the timing of hydronephrosis, castration resistance and creatinine increase, the middle and end of the second year of treatment in this patient group is the most critical time to reevaluate the patient, to reveal new treatment options, and to be alert for possible complications.