THE "NEW" PROSTATE CANCER INFOLINK

A recent German article has reported data on the value of a form of radical transurethral resection of the prostate (TURP) as an alternative form of surgical treatment for localized prostate cancer (instead of radical prostatectomy).

Reuter and Dietz provide information on a total of 533 patients treated using this technique between January 1995 and July 2008. Treatment was carried out with curative intent in all cases.

The procedure used by the authors requires continuous low-pressure irrigation of the prostate, a suprapubic trocar, and other specific technical methods. The prostate is cut out completely, through the urethra, along with the peripheral capsule and the seminal vesicles. The prostate specimen is carefully retrieved in specific fractions for correct histopathological staging. If necessary, laparoscopic staging lymphadenectomy is performed. A secondary session for control of positive margins follows after 8 weeks.

The results reported by the authors are as follows:

• The median age of the patients was 67 years (range, 40-89 years).
• The patients’ pathological tumor stages after surgery were:
  • 43/533 (8 percent) were pT1.
  • 325/533 (61 percent) were pT2.
  • 165/533 (31 percent) were pT3.
• The post-surgical PSA nadir was ≤ 0.2 ng/ml in 422/444 cases (95 percent).
• PSA recurrence at 5 years was 6 percent for pT1, 18 percent for pT2, and 31 percent for pT3 disease.
• Overall post-operative survival at 10 years was 96 percent for pT1, 91 percent for pT2, and 85 percent for pT3 patients.
• The following adverse events were recorded in association with the treatment:
  • Blood transfusions were necessary in 8/533 patients (1.5 percent).
  • Revision for hemorrhage was carried out in 13/533 patients (2.4 percent).
  • A lung embolism occurred in 1 patient (0.2 percent).
  • Bladder neck incisions were carried out in 14 percent of the patients.
• Grade 2 incontinence was reported in 2/314 patients (0.6 percent).
• Impotence was reported in 41/136 patients (30 percent).

Prostate cancer can be resected transurethrally with reasonable oncological results. The outcome with respect to survival and PSA recurrence is comparable with the results of other published procedures. Low-pressure irrigation with a suprapubic trocar is mandatory for safe performance.

It is reasonable to ask whether, with appropriate training, this technique is as good as modern forms of radical prostatectomy (carried out laparoscopically with a robot, without a robot, or as open surgery). However, the other question is whether this technique is one that the urology community actually wants to perform. Reuter and Dietz have apparently been carrying out this procedure since 1995 (i.e., for 14 years at an average of about 40 patients per year) but we are not aware of other prostate cancer surgeons showing any interest in operating this way on prostate cancer patients.

Filed under: Management, Treatment, Uncategorized | Tagged: innovative, outcomes, prostatectomy, transurethral resection