A 68-year-old male presents to your office complaining of difficulty urinating. His past medical history is significant for prostate cancer treated with radiation therapy one year ago. Ultrasonography reveals bilateral dilation of the ureters and renal calyces. If related to the previous therapy, which of the following is the most likely cause of this patient's current condition?

Question

A 68-year-old male presents to your office complaining of difficulty urinating.  His past medical history is significant for prostate cancer treated with radiation therapy one year ago.  Ultrasonography reveals bilateral dilation of the ureters and renal calyces.  If related to the previous therapy, which of the following is the most likely cause of this patient's current condition?

Quizplus · Accepted Answer

Radiotherapy has applications as primary, adjuvant, or more commonly palliative therapy for many types of cancer. Tumor sensitivity to radiation depends on the rate of cell turnover, with rapidly growing tumors being more sensitive. In the same way, rapidly dividing normal body tissues such as blood cell precursors, epithelial surfaces in the skin, GI tract, and urinary tract, and the gonads (gametes) are also at risk for damage. Fibrosis and strictures due to diffuse scarring of the damaged tissues often occurs as a late complication of radiotherapy for prostate cancer, and may lead to obstructive uropathy. (Choice A) Granuloma formation occurs in diseases such as sarcoidosis (sterile, non-caseating granulomas), tuberculosis (caseating necrosis with Langhans giant cells and acid-fast bacilli), and in foreign body reactions (foreign body giant cells, sometimes surrounding an identifiable foreign body). (Choices B & D) Radiation mucositis and mucosal ulceration occur after radiotherapy for gastrointestinal tumors and head and neck malignancies. These early effects resolve soon after discontinuation of treatment. (Choice E) Mucosal hyperplasia is seen in patients treated with phenytoin (gingivae) and can also be seen in states where there is hypersecretion of a hormone that is trophic for a mucosal surface as occurs in the gastric mucosa with gastrinoma. Educational objective: Fibrosis and strictures are late effects of radiation therapy. Radiotherapy for prostate cancer may lead to urethral fibrosis and result in obstructive uropathy.

A 68-Year-Old Male Presents to Your Office Complaining of Difficulty