Prostate cancer--the impact of irradiation on urinary outlet obstruction.

A series of 245 patients with prostate cancer treated by external irradiation was analysed to assess the impact of irradiation on urinary outlet obstruction. Prior to irradiation, obstruction was observed in 147/245 patients (60%). Irradiation either with or without hormonal therapy was as efficacious as transurethral resection of the prostate (TURP) in alleviating obstructive symptoms; 14/16 patients treated by irradiation alone responded, as did 19/19 who received hormonal therapy and irradiation and 109/112 who underwent TURP and irradiation. Following irradiation, 41/245 patients developed post-irradiation obstruction, 26/213 had post-irradiation strictures and 15/32 developed recurrent cancer. Surgical intervention was required less often for the management of recurrent obstruction caused by stricture as compared with recurrent cancer. TURP and urinary outlet obstruction acted as independent and additive variables to the development of post-irradiation stricture. Thus the avoidance of TURP in patients with obstructive symptoms reduced but did not eliminate the risk of developing a stricture.

Prostate cancer: post-irradiation incontinence.

The experience of 272 patients with prostate cancer treated between 1976 and 1987 by external irradiation was reviewed to assess causal factors for post-irradiation incontinence and to determine measures to reduce the risk of this complication. No patient had incontinence before definitive irradiation or radical prostatectomy. Post-irradiation incontinence was observed in 19 of 272 patients (7%), including 14 with mild, 2 with moderate and 3 with severe disease. Incontinence after definitive irradiation was not significantly related to tumor stage or tumor control: 8 of 192 patients (4%) had local control and 2 of 33 (6%) had local failure. Incontinence was related to a urological operation performed in 1 of 105 patients (1%) who underwent needle biopsy and 7 of 130 (5.5%) who underwent transurethral prostatectomy before irradiation. Incontinence was more frequent, 2 of 6 patients (33%), and more severe in patients who underwent transurethral prostatectomy after irradiation. Of 31 patients 9 (29%) were incontinent after radical prostatectomy. No additional patient had incontinence after postoperative irradiation. However, 3 patients had a temporary increase in the severity of incontinence. The risk of post-irradiation incontinence may be decreased by more selective use of transurethral prostatectomy. Of 136 patients 26 (20%) underwent transurethral prostatectomy for tissue diagnosis. A needle biopsy would be the procedure of choice. A total of 29 patients with urinary outlet obstruction was treated without transurethral prostatectomy before irradiation. Ten patients with relatively mild urinary outlet obstruction were treated by irradiation alone, while 19 with more severe urinary outlet obstruction had endocrine therapy before irradiation and none of the 29 patients (0%) had post-irradiation incontinence.

Intractable bladder hemorrhage requiring cystectomy after use of intravesical thiotepa.

A case of nearly exsanguinating bladder hemorrhage, occurring six months after intravesical thiotepa administration, is reported. The hemorrhage was not attributable to myelosuppression. This case also demonstrates the hazard of using formalin to control such hemorrhage.

Response of lymph node metastasis to sequential estrogen and radiation therapy in prostate carcinoma.

Increasingly sophisticated diagnostic studies have shown a high incidence of tumor spread to the regional lymph nodes. The status of the lymph nodes has been evaluated by noninvasive diagnostic procedures such as lymphangiography and computerized axial tomography. The applicability of these procedures has been enhanced by the use of stringent criteria. Gross lymph node metastasis can be diagnosed with considerable confidence. Serial observations of lymphangiograms and computerized axial tomograms before and two months after the administration of estrogens provide an added dimension to the interpretation of lymph node metastasis. The nature and range of the response of lymph node metastasis were observed. Survival of patients with gross lymph node metastasis treated by sequential estrogen and radiation therapy was evaluated. A total of 11/18 (61 per cent) of patients remained free of symptoms, 8/11 (74 per cent) with a favorable lymph node metastasis responsive to estrogen therapy, and 3/7 (42 per cent) with lymph node metastasis refractory to estrogen therapy. Follow-up computerized axial tomograms of the lymph nodes done at one and two years after irradiation showed a persistent favorable response. Five patients are alive with disease, and 2 patients died of the disease.