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J Cancer Res Clin Oncol. 2018 Apr;144(4):751-758. doi: 10.1007/s00432-018-2597-5. Epub 2018 Feb 7.

Oncological effect of palliative transurethral resection of the prostate in patients with advanced prostate cancer: a propensity score matching study.

Author information

1
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
2
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea. cskim37345806@gmail.com.

Abstract

PURPOSE:

We investigated the oncologic effect of palliative transurethral resection of the prostate (pTURP) in patients with prostate cancer who received primary androgen deprivation therapy.

METHODS:

We reviewed 614 patients, including 83 who underwent pTURP; those with incidental prostate cancer were excluded. Patients were divided into the TURP group and non-TURP group. Propensity score matching was performed for comorbidity, initial prostate-specific antigen (PSA), TNM stage, and Gleason score (GS). The Kaplan-Meier method was used to confirm castration-resistant prostate cancer (CRPC), cancer-specific survival (CSS), and overall survival (OS). Cox regression was performed to confirm factors affecting CSS.

RESULTS:

Before matching, the TURP group had a worse TNM stage (p < 0.01) and GS (p = 0.028) and larger prostate volume (50.1 vs. 39.0 cc, p = 0.005) than the non-TURP group. The most common reason for pTURP was acute urinary retention. After matching, the TURP group showed worse outcomes in CRPC (p = 0.003), CSS (p = 0.003), and OS (p = 0.026). In multivariate analysis, factors for predicting CSS were a positive core percent [hazard ratio (HR) 1.015, p = 0.0272], GS (10 vs. ≤8; HR 6.716, p = 0.0008), and TURP within 3 months after biopsy (HR 2.543, p = 0.0482). The resection weight (HR 1.000, p = 0.9730), resection time (HR 1.000, p = 0.3670), and blood transfusion (HR 0.630, p = 0.1860) were not associated with CSS.

CONCLUSIONS:

The oncologic effect of pTURP as cytoreductive operation seems to be limited. Patients who had to receive pTURP due to cancer-related symptoms, especially early necessity of pTURP (within 3 months after biopsy), showed worse clinical courses; therefore, they should be treated more carefully and actively.

KEYWORDS:

Androgen deprivation therapy; Cytoreductive surgery; Palliative surgery; Survival

PMID:
29417257
DOI:
10.1007/s00432-018-2597-5
[Indexed for MEDLINE]

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