The relationship of palliative transurethral resection of the prostate with disease progression in patients with prostate cancer

Abstract

Objectives To test, in a prostate-cancer population-based database, the validity of the finding that in a single-institution series, palliative transurethral resection of prostate (TURP) is associated with an increased risk of progression. Patients and methods Using the Surveillance and End Epidemiology Registry, we identified men who had a TURP subsequent to their diagnosis of prostate cancer, from 1998 or 1999. The outcome of interest was disease progression, as defined by the initiation of androgen-deprivation therapy or procedures indicating progressive urinary obstruction. Multivariable logistic regression analysis was used to assess the adjusted odds of signal events related to disease progression adjusting for the concurrent effect of the covariates. Results There were 29 361 men with prostate cancer and 2742 (9.3%) had a TURP after the diagnosis. These men had a mean age of 75 years and were unlikely to undergo definitive primary treatment. Men receiving TURP were more likely to undergo orchidectomy than men who did not have a TURP (odds ratio 1.64; 95% confidence interval 1.03–2.60) even after adjusting for differences in cancer-directed treatment, tumour stage and grade, prostate-specific antigen level, race, and age at diagnosis. These men were also more likely to have malignant urinary obstruction (ureteric and bladder outlet) than were men who did not have TURP. Conclusion The requirement for TURP is an adverse prognostic marker even when this is adjusted for classical tumour characteristics. Although the exact reasons for this finding are unclear, consideration should be given to adjuvant treatment in patients undergoing TURP.

Holmium laser enucleation of the prostate: patient selection and perspectives

“…About 9.3% of men with prostate cancer undergo TURP for palliation or for multimodal therapy prior to external beam radiation 29. However, channel TURP is overall associated with worse functional outcomes, treatment failure, and urinary incontinence 30,31.…”

Bladder outlet obstruction (BOO) in men with castration‐resistant prostate cancer

“…Studies have shown that palliative TURP is a safe procedure with acceptable peri‐operative morbidity . Some authors have suggested a negative impact on oncological outcomes , whereas others have reported no impact . From a functional aspect, the risks of postoperative urinary retention, re‐operation, urinary incontinence and long‐term catheterization are markedly high , and are greater in men who have progressed to CRPC .…”

The Role of Palliative Surgery in Castration-Resistant Prostate Cancer

“…Palliative transurethral resection of the prostate (TURP) represents the surgical treatment of choice in men with subvesical obstruction and/or recurrent gross hematuria due to locally recurrent CRPC with or without bladder neck infiltration who are not candidates for a radical surgical approach such as salvage RP (SRP) [14,15,16]. It is still discussed controversially if palliative TURP might lead to an accelerated frequency of systemic metastases due to the intraoperative tumor cell shedding, which could result in an increased PCA mortality rate during follow-up.…”

“…Various groups have described a therapeutic success rate of 70-90% in terms of desobstructing the bladder outlet and prevention of recurrent bleeding and bladder clotting [14,15,16]. About 10% of the patients will need surgical reinterventions due to local recurrences during follow-up.…”