A 54-year-old male smoker of 30 cigarettes a day.
She consulted for the first time in Urology in May 2000, for lower urinary tract infection and left nephritic colic.
A rectal examination revealed a fixed, stony and irregular prostate in both lobes.
Ultrasonography showed no abnormalities of interest, except for a proband growth (prostate of approximately 65 grams).
PSA's 223.
Prostate biopsy detects 6 cylinders markedly infiltrated by a Gleason VII adenocarcinoma.
Staging bone scintigraphy showed no evidence of bone pathology. Complete androgen deprivation was initiated with antiandrogens and LH-RH analogues (August 2000).
During follow-up, PSA levels gradually increased (APC 2001: 0.5, August 2001: 0.7, February 2002: 6.4, April 2002: 14), with no worsening of the patient's general condition.
In February and April 2002, the patient came to the emergency department with two episodes of hematuria and urinary retention, requiring catheterization for one month.
Progressively, the obstructive symptoms worsened in two months, reaching the Orifice for Goteo in June 2002.
The flowmetric study in May 2002 shows a maximum flow rate of 2 ml/sec, with recurrence rate of 80 ml.
Due to this clearly obstructive worsening of his disease, transurethral resection of the prostate was proposed.
In July 2002, when the entrance urethra was introduced to perform the resection of the prostate, a penile urethra filled in a mamelon shape of 0.5-1 cm, polypoid, large caliber bladder was observed.
The rest of the bulbar urethra and prostatic urethra is normal, something destructured the latter.
R.T.U. is not performed because of difficult vision.
1.
In July 2002 after verifying a PSA of 22, antiandrogens were withdrawn, maintaining the analogues and including the patient in an Atrasentan trial (M00-244).
The persistence of severe obstructive symptoms justified a resection of the urethral and prostate glands, sending both samples separately to the department of pathological anatomy to obtain the histological filiation of the former.
Bladder catheterization was maintained for 3 weeks.
The histological diagnosis of the urethral tissue was: masses exclusively formed by an adenocarcinoma Gleason X. The diagnosis was the same in relation to the prostatic tissue itself.
At the present time, the patient is in an excellent general state attending the appropriate consultations according to the protocol of the trial, without symptoms derived from his disease.
