Digital rectal examination showed a moderately enlarged benign feeling prostate with firm consistency but no nodularity. This, however, failed and he was re-catheterized. His preoperative haemoglobin, hematocrit and total leukocyte counts were normal.
An uneventful transurethral resection of prostate was done and he was discharged on the second postoperative day after successfully removing the catheter. Serum PSA was 2. The bone scan was negative for any metastatic disease. The blood film was highly suggestive of chronic lymphocytic leukemia, his post-operative haemoglobin concentration was Consultations with the haematologist and oncologists derived a consensus that no further treatment was indicated at that stage.
Regular follow-ups were recommended and further intervention would only be indicated if haemoglobin and platelet counts showed a decline. Watchful waiting was adopted with regular serum PSA and digitial rectal examinations to monitor the prostate cancer status.
Discussion Leukemic infiltration of the prostate is unusual. Most commonly encountered pathology is chronic lymphocytic leukemia. In a necropsy study of male subjects with various types of cancer, Zein et al2 found 18 cases of CLL infiltrating the prostate gland among 88 cases of CLL To our knowledge, prostate cancer associated with chronic lymphocytic leukemia has only been reported once3 in a patient with Klinefelter syndrome with XXY karyotype.
The overall incidence in their experience was 1. Of these, there were 9 cases of CLL for which no further treatment was needed. In their opinion majority of ahematolymphoid malignancies discovered at radical prostatectomy do not require further treatment. Well differentiated adenocarcinoma of prostate with a low Gleason sum in a 74 year old male can be managed by expectant means. Clinically, isolated prostatic involvement by leukemia is generally managed by observation alone5.
In our patient due to low potential for progression and relatively benign natural history of both conditions, considered separately, we opted for watchful waiting which concurred with the wishes of the patient too.
References 1. Butler MR. Prostatic disease in leukemic patients with particular reference to leukemic infiltration of the prostate - a retrospective clinical study. Secondary tumors of the prostate. Adenocarcinoina of the prostate in a 41 year old man with XXY karyotype and chronic lymphocytic leukemia: report of a case. Your health care professional may suggest timed voiding—urinating at set times—to help prevent your bladder from becoming too full.
Another bladder training technique that your health care professional may recommend is double voiding—waiting a short time after you urinate to try and go again—to help make sure your bladder is completely empty after you urinate. Take extra time in the bathroom to relax and empty the bladder completely.
Women should try to relax the muscles around their bladder when they urinate to make it easier to go. Hovering over a toilet seat to avoid touching it does not allow muscles to fully relax and may result in urine being left in the bladder. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public.
Draining the bladder With acute urinary retention , a health care professional will immediately drain the urine from your bladder using a catheter. If your bladder becomes too full, a health care professional may use a catheter to drain the urine from your bladder. Medicines Your health care professional may suggest that you take medicine to help treat the medical condition causing your urinary retention 5-alpha reductase inhibitors help to stop the growth of or shrink the prostate , which can improve the flow of urine.
Examples include dutasteride and finasteride. Alpha-blockers treat the symptoms of prostate enlargement benign prostatic hyperplasia by relaxing muscles in the bladder neck and prostate, which makes it easier to urinate. Examples include alfuzosin , doxazosin , prazosin , silodosin , tadalafil , tamsulosin , and terazosin. A combination of a 5-alpha-reductase inhibitor and an alpha-blocker , such as finasteride and doxazosin or dutasteride and tamsulosin, may work better than an individual medicine alone.
Antibiotics treat infections that may cause urinary retention, such as urinary tract infections and prostatitis. Medical procedures and devices Your health care professional may recommend a medical procedure or device to treat your urinary retention, depending on the cause of the retention.
Some of these treatments may include removing part of the prostate repairing urethral strictures or bladder neck scar tissue repairing pelvic organ prolapse removing a tumor, abnormal uterus , or damaged portion of a herniated disc repairing an abnormal bladder performing a urinary diversion procedure to reroute the normal flow of urine out of your body How can I treat my urinary retention? Do physical therapy Your health care professional may suggest that you work with a physical therapist who specializes in pelvic floor problems.
Physical therapy can help you gain control over your urinary retention symptoms. Train your bladder Your health care professional may suggest timed voiding—urinating at set times—to help prevent your bladder from becoming too full. Previous: Diagnosis.
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