Cáncer de próstata localmente avanzado con síntomas urinarios obstructivos: Reporte de caso más revisión

Jefferson Rolando Guevara-Castillo; Manuel Andrés Rios-Quezada; James Karlyle Torres-Chamba; Lider Alfredo Chavez-Pinargote

Authors

Guevara-Castillo Jefferson Rolando Médico general, Hospital Básico Yantzaza. Zamora Chinchipe, Ecuador. https://orcid.org/0000-0001-8653-3737
Rios-Quezada Manuel Andrés Médico general, SOLCA. Loja, Ecuador. https://orcid.org/0000-0001-5923-618X
Torres-Chamba James Karlyle Médico General. Loja, Ecuador. https://orcid.org/0009-0005-2058-0537
Chavez-Pinargote Lider Alfredo Médico familiar, Dirección Distrital 17D11 Mejía–Rumiñahui. Ecuador. https://orcid.org/0009-0001-3507-4064

Keywords:

prostatic neoplasms; locally advanced disease; lower urinary tract symptoms; urinary retention; radiation therapy; androgen deprivation therapy

Abstract

DOI: https://doi.org/10.46296/gt.v9i18.0411

Abstract

Background: Locally advanced prostate cancer may cause obstructive urinary symptoms, although these are nonspecific. Objective: To synthesize evidence on diagnostic assessment, complications, and multimodal treatment. Methods: A structured narrative review of PubMed/MEDLINE, SciELO, the VHL/LILACS portal, guidelines and primary reports published by October 30, 2026; no meta-analysis or PRISMA counts were conducted. Results: Randomized trials support radiotherapy with prolonged androgen deprivation in selected nonmetastatic disease and abiraterone intensification for defined high-risk groups. In 2026, GETUG-AFU 18 reported improved progression-free survival with 80-Gy versus 70-Gy radiotherapy, whereas ENZARAD did not show a significant overall benefit from enzalutamide intensification. Retention, hydronephrosis and renal impairment require specific urological management separate from cancer control. Conclusions: Obstruction relief and oncological treatment require individualized, multidisciplinary decisions based on stage, risk, and baseline urinary function.

Keywords: prostatic neoplasms; locally advanced disease; lower urinary tract symptoms; urinary retention; radiation therapy; androgen deprivation therapy.

Downloads

Download data is not yet available.

References

European Association of Urology. EAU Guidelines on Prostate Cancer: treatment [Internet]. Arnhem: EAU; 2026 [consultado nov 2026]. Disponible en: https://uroweb.org/guidelines/prostate-cancer/chapter/treatment

European Association of Urology. EAU Guidelines on Prostate Cancer: diagnostic evaluation [Internet]. Arnhem: EAU; 2026 [consultado nov 2026]. Disponible en: https://uroweb.org/guidelines/prostate-cancer/chapter/diagnostic-evaluation

National Cancer Institute. Prostate Cancer Treatment (PDQ®)–Health Professional Version [Internet]. Bethesda: NCI [consultado nov 2026]. Disponible en: https://www.cancer.gov/types/prostate/hp/prostate-treatment-pdq

Young SM, Bansal P, Vella ET, Finelli A, Levitt C, Loblaw A. Systematic review of clinical features of suspected prostate cancer in primary care. Can Fam Physician. 2015;61(1):e26-e35. PMID:25756146.

Prostate Cancer UK. Managing symptoms in advanced prostate cancer [Internet]. [consultado nov 2026]. Disponible en: https://rebuild-prd.prostatecanceruk.org/prostate-information-and-support/advanced-prostate-cancer/managing-symptoms-in-advanced-prostate-cancer

National Institute for Health and Care Excellence. Lower urinary tract symptoms in men: management. Clinical guideline CG97 [Internet]. Londres: NICE; 2010 [consultado nov 2026]. Disponible en: https://www.nice.org.uk/guidance/cg97/chapter/recommendations

Hofman MS, Lawrentschuk N, Francis RJ, et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet. 2020;395(10231):1208-1216. doi:10.1016/S0140-6736(20)30314-7.

Pelletier J, Cyr SJ, Julien AS, Fradet Y, Lacombe L, Toren P. Contemporary outcomes of palliative transurethral resection of the prostate in patients with locally advanced prostate cancer. Urol Oncol. 2018;36(8):363.e7-363.e11. doi:10.1016/j.urolonc.2018.05.004.

Celada Álvarez FJ. Incontinencia urinaria, cáncer de próstata y radioterapia externa. Arch Esp Urol. 2009;62(10). Disponible en: https://scielo.isciii.es/scielo.php?pid=S0004-06142009001000006&script=sci_arttext

Mason MD, Parulekar WR, Sydes MR, et al. Final report of the intergroup randomized study of combined androgen-deprivation therapy plus radiotherapy versus androgen-deprivation therapy alone in locally advanced prostate cancer. J Clin Oncol. 2015;33(19):2143-2150. doi:10.1200/JCO.2014.57.7510.

Widmark A, Klepp O, Solberg A, et al. Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial. Lancet. 2009;373(9660):301-308. doi:10.1016/S0140-6736(08)61815-2.

Attard G, Murphy L, Clarke NW, et al. Abiraterone acetate and prednisolone with or without enzalutamide for high-risk non-metastatic prostate cancer: a meta-analysis of primary results from two randomised controlled phase 3 trials of the STAMPEDE platform protocol. Lancet. 2022;399(10323):447-460. doi:10.1016/S0140-6736(21)02437-5.

Mayor de Castro J, Caño Velasco J, Aragón Chamizo J, et al. Cáncer de próstata localmente avanzado. Definición, diagnóstico y tratamiento. Arch Esp Urol. 2018;71(3):231-238. PMID:29633943.

Hennequin C, Sargos P, Roca L, et al. High-dose radiotherapy in patients with high-risk prostate cancers treated with long-term androgen deprivation therapy (GETUG AFU 18): a randomised, phase 3 trial. Lancet Oncol. 2026;27(9):1158-1167. doi:10.1016/S1470-2045(26)00277-9.

Williams S, Sweeney CJ, Thomas H, et al. ENZARAD (ANZUP 1303): phase 3 trial of enzalutamide with androgen deprivation therapy and radiation therapy in high-risk localized or locally advanced prostate cancer. J Clin Oncol. Publicado en línea el 24 oct 2026. doi:10.1200/JCO-26-01794.

Bolla M, de Reijke TM, Van Tienhoven G, et al. Duration of androgen suppression in the treatment of prostate cancer. N Engl J Med. 2009;360(24):2516-2527. doi:10.1056/NEJMoa0810095.

Ferrandis C, March JA, Martínez JM, et al. Tratamiento combinado con radioterapia externa y hormonoterapia en los pacientes con cáncer de próstata localmente avanzado: factores predictivos de toxicidad genitourinaria. Actas Urol Esp. 2011;35(3):146-151. doi:10.1016/j.acuro.2010.08.006.

Seguro Social de Salud (EsSalud), Instituto de Evaluación de Tecnologías en Salud e Investigación. Guía de práctica clínica para el tamizaje, diagnóstico y tratamiento inicial de cáncer de próstata localizado y localmente avanzado [Internet]. Lima: EsSalud; 2021. Disponible en: https://repositorio.essalud.gob.pe/handle/20.500.12959/1879

Esquena Fernández S, Maroto Rey P, Sancho Pardo G, Palou Redorta J, Villavicencio Mavrich H. Tratamiento actual del cáncer de próstata de alto riesgo y localmente avanzado. Actas Urol Esp. 2007;31(5):445-451. doi:10.1016/S0210-4806(07)73667-7.

LOCALLY ADVANCED PROSTATE CANCER WITH OBSTRUCTIVE URINARY SYMPTOMS: CASE REPORT AND REVIEW

Authors

Keywords:

Abstract

Downloads

References

Published

How to Cite

Issue

Section

Make a Submission