Skip to main content

Advertisement

SpringerLink
Log in

The Diminishing Role of Transurethral Resection of the Prostate

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study provides an update of patterns in transurethral resection of the prostate (TURP) rates in the United States and the extent of TURP-detected prostate cancer incidence rates.

Methods

Analyses are based on data from the National Hospital Discharge Survey, the Surveillance, Epidemiology, and End Results Program, and the U.S. Census Bureau for the years 1996 through 2006.

Results

TURP procedure rates were 6, 14, and 18 times greater in men aged 60 to 69, 70 to 79, and ≥80 years compared with men aged 50 to 59, respectively. During 1996–2006, the estimated annual percentage change in TURP rates was −10.5 (95% confidence interval [95% CI] −14.1 to −6.7) for ages 50 to 59, −7.4 (95% CI −9.2 to −5.6) for ages 60 to 69, −6.2 (95% CI −7.6 to −4.8) for ages 70 to 79, and −7.7 (95% CI −9.5 to −5.8) for ages ≥80 years. TURP-detected prostate cancer incidence rates were 2, 7, and 17 times greater in men aged 60 to 69, 70 to 79, and ≥80 years compared with men aged 50 to 59, respectively. The estimated annual percentage change in trend was −17.8 (−20.6, −15.0) for ages 50 to 59, −14.8 (−16.6, −13.0) for ages 60 to 69, −10.8 (−12.0, −9.7) for ages 70 to 79, and −8.2 (−10.0, −6.5) for ages ≥80 years. Trends in prostate cancer incidence rates peaked in 2002 and decreased thereafter. Some of the decreasing trend in rates among older age groups is because of a decrease in TURPs and consequently a decrease in incidental TURP-detected cases.

Conclusions

TURP procedure rates and incidental TURP-detected prostate cancer incidence rates have declined and will likely continue to decline in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Andrews GS. Latent carcinoma of the prostate. J Clin Pathol. 1949;2:197.

    Article  Google Scholar 

  2. Edwards CN, Steinthorsson E, Nicholson D. An autopsy of latent prostatic cancer. Cancer. 1953;6:531.

    Article  CAS  PubMed  Google Scholar 

  3. Hirst AE Jr, Bergman RT. Carcinoma of the prostate in men 80 or more years old. Cancer. 1954;7:136.

    Article  PubMed  Google Scholar 

  4. Whitmore WF Jr. Symposium of hormones and cancer therapy hormone therapy in prostatic cancer. Am J Med. 1956;21:295.

    Google Scholar 

  5. Scott R Jr, Mutchnik DL, Laskowski TZ, et al. Carcinoma of the prostate in elderly men: incidence, growth characteristics and clinical significance. J Urol. 1969;101:602.

    PubMed  Google Scholar 

  6. Breslow N, Chan CW, Dhom G, et al. Latent carcinoma of the prostate at autopsy in seven areas. Int J Cancer. 1977;20:680–8.

    Article  CAS  PubMed  Google Scholar 

  7. Carter HB, Piantadosi S, Isaacs JT. Clinical evidence for and implications of the multistep development of prostate cancer. J Urol. 1990;143:742–6.

    CAS  PubMed  Google Scholar 

  8. Kirby RS. The natural history of benign prostatic hyperplasia: what have we learned in the last decade? Urology. 2000;56:3–6.

    Article  CAS  PubMed  Google Scholar 

  9. Platz EA, Smit E, Curhan GC, et al. Prevalence of and racial/ethnic variation in lower urinary tract symptoms and noncancerprostate surgery in US men. Urology. 2002;59:877–83.

    Article  PubMed  Google Scholar 

  10. Trueman P, Hood SC, Nayak USL, et al. Prevalence of lower urinary tract symptoms and self-reported diagnosed “benign prostatic hyperplasia,” and their effect on quality of life in a community-based survey of men in the UK. BJU Int. 1999;83:410–15.

    Article  CAS  PubMed  Google Scholar 

  11. Barry MJ. Epidemiology and natural history of benign prostatic hyperplasia. Urol Clin North Am. 1990;17:495–507.

    CAS  PubMed  Google Scholar 

  12. Fitzpatrick JM. The natural history of benign prostate hyperplasia. BJU Int. 2006;97(Suppl 2):3–6.

    Article  PubMed  Google Scholar 

  13. Geller J. Effect of finasteride, a 5 alpha-reductase inhibitor on prostate tissue androgens and prostate-specific antigen. J Clin Endocrinol Metab. 1990;71:1552–5.

    Article  CAS  PubMed  Google Scholar 

  14. Crea G, Sanfilippo G, Anastasi G, et al. Pre-surgical finasteride therapy in patients treated endoscopically for benign prostatic hyperplasia. Urol Int. 2005;74:51–3.

    Article  CAS  PubMed  Google Scholar 

  15. Tacklind J, Fink HA, MacDonald R, et al. Finasteride for benign prostatic hyperplasia (Protocol). Cochrane Database Syst Rev. 2009;(3):CD006015.

  16. Roehrborn CG, Boyle P, Nickel JC, et al. Efficacy and safety of a dual inhibitor of 5-alpha-reductase types 1 and 2 (dutasteride) in men with benign prostatic hyperplasia. Urology. 2002;60:434–41.

    Article  PubMed  Google Scholar 

  17. Andriole GL, Roehrborn C, Schulman C, et al. Effect of dutasteride on the detection of prostate cancer in men with benign prostatic hyperplasia. Urology. 2004;64:537–41.

    Article  CAS  PubMed  Google Scholar 

  18. Roehrborn CG, Marks LS, Fenter T, et al. Efficacy and safety of dutasteride in the four-year treatment of men with benign prostatic hyperplasia. J Urol. 2005;173:515.

    Google Scholar 

  19. Wilt T, MacDonald R, Hagerty K, et al. Five-alpha-reductase inhibitors for prostate cancer prevention. Cochrane Database Syst Rev. 2008;(2):CD007091.

  20. Roehrborn CG, Siami P, Barkin J, et al. The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement:2-year results from the CombAT study. J Urol. 2008;179:616–21.

    Article  CAS  PubMed  Google Scholar 

  21. Schulman CC, Cortvriend J, Jonas U, et al. Tamsulosin:3-year long-term efficacy and safety in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction: analysis of a European, multinational, multicenter, open-label study. Eur Urol. 1999;36:609–20.

    Article  CAS  PubMed  Google Scholar 

  22. Lepor H. Long-term evaluation of tamsulosin in benign prostatic hyperplasia: placebo-controlled, double-blind extension of phase III trial. Urology. 1998;51:901–6.

    Article  CAS  PubMed  Google Scholar 

  23. Abrams P, Schulman CC, Vaage S. Tamsulosin, a selective alpha 1c-adrenoceptor antagonist: a randomized, controlled trial in patients with benign prostatic “obstruction” (symptomatic BPH). Br J Urol. 1995;76:325–36.

    Article  CAS  PubMed  Google Scholar 

  24. Narayan P. Tamsulosin: the United States trials. Geriatrics. 1998;53:S29–32.

    PubMed  Google Scholar 

  25. Chapple C, Andersson KE. Tamsulosin: an overview. World J Urol. 2002;19:397–404.

    CAS  PubMed  Google Scholar 

  26. Jardin A, Bensadoun H, Delauche-Cavallier MC, Attali P. Alfuzosin for treatment of benign prostatic hypertrophy. Lancet. 1991;337(8755):1457–61.

    Article  CAS  PubMed  Google Scholar 

  27. Jardin A, Bensadoun H, Delauche-Cavallier MC, Stalla-Bourdillon A, Attali P. Long-term treatment of benign prostatic hyperplasia with alfuzosin: a 24–30 month survey. Br J Urol. 1994;74:579–84.

    Article  CAS  PubMed  Google Scholar 

  28. Roehrborn CG. Efficacy and safety of once-daily alfuzosin in the treatment of lower urinary tract symptoms and clinical benign prostatic hyperplasia: a randomized, placebo-controlled trial. Urology. 2001;58:953–9.

    Article  CAS  PubMed  Google Scholar 

  29. Jardin A, Bensadoun H, Delauche-Cavallier MC, et al. Alfuzosin for treatment of benign prostatic hypertrophy. The BPH-ALF Group. Lancet. 1991;338(8760):182.

    Google Scholar 

  30. Vallancien G, Emberton M, Alcaraz A, et al. Alfuzosin 10 mg once daily for treating benign prostatic hyperplasia: a 3-year experience in real-life practice. BJU Int. 2008;101:847–52.

    Article  CAS  PubMed  Google Scholar 

  31. McVary KT. Alfuzosin for symptomatic benign prostatic hyperplasia: long-term experience. J Urol. 2006;175:35–42.

    Article  CAS  PubMed  Google Scholar 

  32. Takao T, Tsujimura A, Kiuchi H, et al. Early efficacy of silodosin in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Int J Urol. 2008;15:992–6.

    PubMed  Google Scholar 

  33. Kawabe K, Yoshida M, Homma Y. Silodosin, a new alpha1A-adrenoceptor-selective antagonist for treating benign prostatic hyperplasia: results of a phase III randomized, placebo-controlled, double-blind study in Japanese men. BJU Int. 2006;98:1019–24.

    Article  CAS  PubMed  Google Scholar 

  34. Marks LS, Gittelman MC, Hill LA, Volinn W, Hoel G. Rapid efficacy of the highly selective alpha1A-adrenoceptor antagonist silodosin in men with signs and symptoms of benign prostatic hyperplasia: pooled results of 2 phase 3 studies. J Urol. 2009;181:2634–40.

    Article  CAS  PubMed  Google Scholar 

  35. Merrill RM, Feuer EJ, Warren JL, et al. Role of transurethral resection of the prostate in population-based prostate cancer incidence rates. Am J Epidemiol. 1999;150:848–60.

    CAS  PubMed  Google Scholar 

  36. Catalona WJ, Smith DS, Ratliff TL, et al. Detection of organ-confined prostate cancer is increased through prostate-specific antigen-based screening. JAMA. 1993;270:948–54.

    Article  CAS  PubMed  Google Scholar 

  37. Potosky AL, Miller BA, Albertsen PC, et al. The role of increasing detection in the rising incidence of prostate cancer. JAMA. 1995;273:548–52.

    Article  CAS  PubMed  Google Scholar 

  38. Merrill RM, Potosky AL, Feuer EJ. Changing trends in US prostate cancer incidence rates. J Natl Cancer Inst. 1996;88:1683–5.

    Article  CAS  PubMed  Google Scholar 

  39. Dennison C, Pokras R. Design and operation of the National Hospital Discharge Survey: 1988 redesign. Vital Health Statistics, Series 1, 2000;39. June 19, 2006. Available at: http://www.cdc.gov/nchs/data/series/sr_01/sr01_039.pdf. Accessed July 24, 2009.

  40. National Center for Health Statistics. National Hospital Discharge Survey Annual Summary, 1996, 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006 (machine-readable data file and documentation). Hyattsville, MD: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2007.

  41. Ries LAG, Kosary CL, Hankey BF, et al., editors. SEER Cancer Statistics Review, 1973–94. NIH Pub. No. 97-2789. Bethesda, MD: National Cancer Institute; 1997.

  42. Centers for Disease Control and Prevention, National Center for Health Statistics. Available at: http://www.cdc.gov/nchs. Accessed June 12, 2009.

  43. Surveillance, Epidemiology, and End Results (SEER) Program SEER*Stat Database: Incidence—SEER 13 Regs Limited-Use, Nov 2008 Sub (1992–2006) Katrina/Rita Population Adjustment—Linked to County Attributes—Total US, 1969–2006 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2009, based on the November 2008 submission. Available at: http://www.seer.cancer.gov. Accessed July 24, 2009.

  44. Kleinbaum DG, Kupper LL, Muller KE 1988 Applied Regression Analysis of Other Multivariable Methods. North Scituate, MA: Duxbury Press, pp 266–8.

    Google Scholar 

  45. US Department of Health and Human Services. International Classification of Diseases, Ninth Revision. Clinical modification (ICD-9-CM). 3rd ed. DHHS Publication No. (PHS) 89-1260. Hyattsville, MD: US Department of Health and Human Services; 1989.

  46. SEER site-specific surgery of primary site codes. Available at: http://seer.cancer.gov/tools/SEER2003.surg.prim.site.codes.pdf. Accessed June 12, 2009.

  47. Jones JS, Follis HW, Johnson JR. Probability of finding T1a and T1b (incidental) prostate cancer during TURP has decreased in the PSA era. Prostate Cancer Prostatic Dis. 2009;12:57–60.

    Article  CAS  PubMed  Google Scholar 

  48. Hoffman RM, Monga M, Elliot SP, et al. Microwave thermotherapy for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2007;(4):CD004135.

  49. Johns Hopkins guide to BPH. Available at: http://www.johnshopkinshealthalerts.com/reports/pdfs/BPH-special-report.pdf. Accessed May 27, 2009.

  50. Benign prostatic hyperplasia—diagnosis and treatment options at the Mayo Clinic. Available at: http://www.mayoclinic.org/bph/. Accessed May 27, 2009.

  51. Boyle P, Robertson C, Vaughan ED. A meta-analysis of trials of transurethral needle ablation for treating symptomatic benign prostatic hyperplasia. BJU Int. 2004;94:83–8.

    Article  PubMed  Google Scholar 

  52. Potosky AL, Miller BA, Albertsen PC, et al. The role of increasing detection in the rising incidence of prostate cancer. JAMA. 1995;273:548–52.

    Article  CAS  PubMed  Google Scholar 

  53. Etzioni R, Gulati R, Falcon S, et al. Impact of PSA screening on the incidence of advanced stage prostate cancer in the United States: a surveillance modeling approach. Med Decis Making. 2008;28:323–31.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Health Science, College of Life Sciences, Brigham Young University, Provo, UT, USA

    Ray M. Merrill PhD, MPH & Bradley D. Hunter BA

Authors
  1. Ray M. Merrill PhD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bradley D. Hunter BA
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ray M. Merrill PhD, MPH.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Merrill, R.M., Hunter, B.D. The Diminishing Role of Transurethral Resection of the Prostate. Ann Surg Oncol 17, 1422–1428 (2010). https://doi.org/10.1245/s10434-009-0896-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-009-0896-4

Keywords

Search

Navigation