From the Guidelines
The treatment for hydronephrosis in stage 4 prostate cancer should prioritize relieving the urinary obstruction and addressing the underlying cancer with androgen deprivation therapy (ADT) and novel systemic agents, such as abiraterone or docetaxel, as recommended by recent guidelines 1. The initial management of hydronephrosis involves decompressing the urinary system through placement of a percutaneous nephrostomy tube or ureteral stent to drain the blocked kidney. For immediate relief, a urinary catheter may be placed if the obstruction is at the bladder level.
- Key considerations in the treatment of stage 4 prostate cancer include:
- The use of ADT, which is the primary systemic treatment for metastatic prostate cancer
- The addition of novel systemic agents, such as abiraterone or docetaxel, for patients with de novo metastatic hormone-sensitive prostate cancer (mHSPC)
- The consideration of other treatment options, such as darolutamide or enzalutamide, for patients with mHSPC
- According to the recent guidelines 1, ADT plus abiraterone or docetaxel is recommended as first-line treatment for fit men with de novo mHSPC, especially in those with multiple bone metastases or visceral metastases.
- Pain management is also an important aspect of treatment, and may include opioids, NSAIDs, or palliative radiation therapy.
- Regular monitoring of renal function through blood tests and imaging is essential to assess treatment response and adjust the treatment plan as needed, as recommended by the guidelines 1.
From the Research
Treatment Options for Hydronephrosis in Stage 4 Prostate Cancer
The treatment for hydronephrosis in stage 4 prostate cancer involves relieving the obstruction in the urinary tract. The following options are available:
- Nephrostomia: This involves placing a catheter directly into the kidney to drain the urine into a bag outside the body 2.
- Internal urinary diversion: This involves placing a double-J ureteral stent to divert the urine from the kidney into the bladder 2.
- Percutaneous nephrostomy: This involves creating a hole in the skin to insert a catheter into the kidney to drain the urine 3, 4.
Factors Influencing Treatment Choice
The choice of treatment depends on various factors, including:
- Patient's overall health: Nephrostomies are preferred for patients in poor health, while double-J stents are preferred for healthier patients 2.
- Presence of infections: Nephrostomies are preferred for patients with infections 2.
- Kidney function: Double-J stents are more effective for patients with well-functioning kidneys and bladder 2.
Efficacy and Safety of Treatment Options
Studies have shown that:
- Nephrostomies and double-J stents are safe and effective in relieving ureteral obstruction 2, 3.
- Percutaneous nephrostomy can improve renal function and survival in patients with renal failure 3.
- Double-J stents can last longer than nephrostomies, but may require more frequent replacements 2.
Quality of Life Considerations
Treatment options can impact quality of life, with: