Abstract
Background: Patients with gross haematuria are sometimes found to have prostate cancer after clinical evaluation. The treatment of such haematuria could be very challenging. Use of a 5 alpha reductase inhibitor like dutasteride has been found helpful in bleeding prostate cancer patients if they have not undergone hormonal manipulation before they developed haematuria. Patients and Method: 26 patients with gross haematuria of prostatic origin who had histologic confirmation of adenocarcinoma of the prostate but who have not had chemical or surgical castration were randomized to receive daily dutasteride in addition to vigorous saline irrigation and antibiotics on one arm and vigorous saline irrigation and antibiotics only as control on the other arm. The time taken before haematuria resolved and the amount of irrigation fluid used were noted. Statistical analysis was done using SPSS. Student’s t-test and Kaplan Meier survival analysis were used to test various variables at 0.5 significant levels. Results: Of the 26 patients 12(46.2%) received 0.5 mg oral dutasteride in addition to saline irrigation while 14 (53.8%) received saline irrigation only. Haematuria stopped in all of 12 (100%) patients on dutasteride arm but on 12 (85.7%) of the 14 patients on the control arm. It took significantly shorter time and lesser volume of irrigation fluid before haematuria resolved in those treated with dutasteride than in those on the control arm. Conclusion: Dutasteride is effective in the control of acute haematuria in pre-androgen ablation prostate cancer patients.
Highlights
It can result from the cancer itself or as a side effect of previous treatments such as haematuria resulting from acute or chronic toxicity of radiotherapy, and haematuria resulting from a site of stone formation on a suture line in patients who have had radical prostatectomy [2]
In 2 (14.3%) patients on the control arm haematuria did not resolve after 30 days, so they were offered subcapsular orchidectomy
The patients on the dutasteride arm required between 3 litres and 20 litres with a mean volume of 8.3 ± 4.6 litres of irrigation fluid before haematuria resolved while those on the control arm required between 4 litres and 48litres with a mean volume of 17.4 ± 9.7 litres before haematuria resolved (Table 2)
Summary
Haematuria of cancer of prostate origin can occur from different sources. It can result from the cancer itself or as a side effect of previous treatments such as haematuria resulting from acute or chronic toxicity of radiotherapy, and haematuria resulting from a site of stone formation on a suture line in patients who have had radical prostatectomy [2]. Patients and Method: 26 patients with gross haematuria of prostatic origin who had histologic confirmation of adenocarcinoma of the prostate but who have not had chemical or surgical castration were randomized to receive daily dutasteride in addition to vigorous saline irrigation and antibiotics on one arm and vigorous saline irrigation and antibiotics only as control on the other arm. Conclusion: Dutasteride is effective in the control of acute haematuria in pre-androgen ablation prostate cancer patients
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