Outcome of transurethral prostatectomy for the palliative management of lower urinary tract symptoms in men with prostate cancer

• Published in: International journal of urology 2006-06, Vol.13 (6), p.711-715
• Main Authors: GNANAPRAGASAM, VINCENT J, KUMAR, VINOD, LANGTON, DAVID, PICKARD, ROBERT S, LEUNG, HING Y
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Humans; lower urinary tract symptom; Male; Middle Aged; outcome; palliation; Palliative Care - methods; predictive factor; Prostatic Hyperplasia - complications; Prostatic Hyperplasia - therapy; Prostatic Neoplasms - complications; Prostatic Neoplasms - therapy; Retrospective Studies; transurethral prostatectomy; Transurethral Resection of Prostate - adverse effects; Transurethral Resection of Prostate - methods; Treatment Outcome; Urinary Incontinence - etiology
• ISSN: 0919-8172; 1442-2042
• DOI: 10.1111/j.1442-2042.2006.01391.x

Objective:  To investigate the efficacy of palliative transurethral prostatectomy (TURP) for lower urinary tract symptoms (LUTS) in men with prostate cancer. Patients and method:  The surgical outcome of TURP performed in 46 men with prostate cancer was studied. A poor outcome was defined as the development of urinary incontinence, repeat surgery and placement of a long‐term catheter (LTC) within 1 year of surgery. A cohort of 47 men who underwent TURP for benign prostatic hyperplasia (BPH) was used as a control population. Results:  Initial catheter removal failed in a larger number of cancer patients compared to men with BPH (43% and 10%, respectively, P = 0.0001). Using objective endpoints, 37% (17/46) of cancer patients were defined as having a poor outcome because of repeat surgery, placement of a LTC or urinary incontinence following TURP. These events occurred in only 12% (6/47) of the control cohort (P = 0.004). In multiple regression analysis a good outcome was associated with presentation in acute urinary retention (AUR; P = 0.01) while a poor outcome was associated with surgery in the context of hormone refractory disease (P = 0.004). Requirement for a LTC despite surgery (12/46) was also associated with the absence of AUR at presentation (P = 0.01) and hormone refractory disease (P = 0.01). Conclusion:  A significant number of men with prostate cancer and LUTS may not derive a good palliative benefit from TURP. Patients with hormone refractory disease in particular are more likely to have poorer outcomes.