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.
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Funding
This study was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health and Welfare, Republic of Korea (Grant Number: HI15C0972).
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All authors declare that they have no conflict of interest.
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The study protocol was approved by the Institutional Review Board of the Asan Medical Center (2017-0129). All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board of the Asan Medical Center and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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The Institutional Review Board of the Asan Medical Center waived the requirement for informed consent because of the retrospective design of this study.
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Choi, S.Y., Ryu, J., You, D. et al. Oncological effect of palliative transurethral resection of the prostate in patients with advanced prostate cancer: a propensity score matching study. J Cancer Res Clin Oncol 144, 751–758 (2018). https://doi.org/10.1007/s00432-018-2597-5
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DOI: https://doi.org/10.1007/s00432-018-2597-5