Metastatic Prostate Cancer under Androgen Deprivation Therapy: Factors Influencing Castration Resistance

Objective: To evaluate the factors predicting the time to progression to castration-resistant in metastatic prostate cancer under Androgen Deprivation Therapy (ADT) in our center. Patients and Methods: This is a retrospective, descriptive, analytical study in a single center over a period of 2 years. It has interest patients followed for metastasized prostate cancer under ADT. The parameters studied were: epidemiological, clinical, paraclinical, prostate specific antigen (PSA) nadir, time to nadir (TTN) and their link with the castration resistance. Results: The frequency of castration resistant prostate cancer was 28 patients per year. The mean age was 70.4 ± 7.9 years. An ECOG score ≥ 3 was more common as was the cT2c stage. The median of the initial total PSA was 489.6 ng/ml (203.3;1653.2). All patients had adenocarcinoma. The International Society of Urological Pathology (ISUP) 1 was more frequent. Bone metastases were more frequent. The medians of nadir, TTN and the castration resistance were 19.3 ng/ml (3.7;102.1), 5.5 months (3;9) and 11 months (6;15.3), respectively. The Eastern Cooperative Oncology Group (ECOG) score, clinical stage, metastatic site, the nadir and its TTN influenced the DSR. Age, lymph node involvement, initial total PSA and Gleason score did not influence the castration resistance. Conclusion: ADT should be initiated as soon as possible before an attack of general and/or clinical stage advanced to delay resistance. A drilling should be associated with this hormone therapy as much as possible because of its gain on resistance.

Diversion of the Upper Urinary Tract by A Double J Catheter: Indications and Results in A Retrospective Study from the Sino-Guinean Friendship Hospital in Conakry (Guinea): About 45 Cases

Introduction: In the presence of renal cavities dilatation with or without renal insufficiency, or in the presence of a risk of extrinsic or intrinsic occlusion of the ureteral lumen, the JJ catheter constitutes a minimally invasive alternative for the diversion of the upper urinary tract. The aim of this work was to report the indications and results of the diversion of the upper urinary tract by JJ catheter in our department. Materials and Methods: Retrospective descriptive study with analytical and monocentric aim concerning the diversion of the upper urinary tract by a JJ catheter from the hospitalization records of our department from January 1, 2022 to December 31, 2023 at the Sino-Guinean Friendship Hospital. Results: We identified 45 cases of obstructive renal failure. The incidence of obstructive renal failure was 22.5 cases/year. The most common reason for consultation was lower back pain. Physical examination was normal in all patients. Preoperative creatinine was high in all our patients. Ultrasound revealed dilatation of the upper urinary tract in all patients. The surgical indications were dominated by obstructive ureteral stones in 24% of cases, followed by ureteropelvic junction syndrome in 22% of cases. Management consisted of drainage of the upper urinary tract by endoscopic insertion of a JJ catheter. The etiologies were dominated by ureteral stenosis (64.29%), followed by compression of the ureter by the pregnant uterus (14.29%). The evolution was favorable in all our patients with a normalization of creatinine level on post-operative day 2. Conclusion: The placement of ureteral stents has become a common procedure in the management of various obstructive pathological processes of the urinary tract.