USE OF DEXAMETHASONE FOR URETERAL OBSTRUCTION IN ADVANCED PROSTATE-CANCER - PERCUTANEOUS NEPHROSTOMIES CAN BE AVOIDED

Objective To evaluate the effectiveness of dexamethasone in relieving bilateral lower ureteric obstruction in the acute phase of renal failure secondary to locally advanced prostate cancer. Patients and methods This study comprised 11 patients (median age 72 years, range 52-84) presenting with advanced prostate cancer, bilateral ureteric obstruction and gross renal failure, Their response to immediate administration of intravenous followed by oral dexamethasone for 4 weeks, in conjunction with definitive treatment and final outcome, was evaluated. Results Renal function improved in 10 patients within 72 h, avoiding the need for insertion of percutaneous nephrostomies. However, four of 10 patients whose renal failure initially improved, failed to respond to definitive therapy, and died 3 to 4 weeks after cessation of the steroids. Conclusion When administered in the acute phase of renal failure from prostate cancer, dexamethasone may obviate the need for urinary diversion in patients with bilateral ureteric obstruction, particularly in men who will not respond favourably to available forms of therapy for advanced and aggressive disease.