Joanie Pelletier1, Sarah-Jeanne Cyr1, Anne-Sophie Julien2, Yves Fradet1, Louis Lacombe1, Paul Toren3. 1. Department of Surgery, Faculty of Medicine, Université Laval, Québec, Canada. 2. Clinical Research Platform, Research Centre of the CHU de Québec-Université Laval, Québec, Canada. 3. Department of Surgery, Faculty of Medicine, Université Laval, Québec, Canada. Electronic address: paul.toren@crchudequebec.ulaval.ca.
Abstract
BACKGROUND: Advanced prostate cancer may cause significant local complications which affect quality of life, including bladder outlet obstruction and hematuria. We performed a detailed review of our outcomes of palliative transurethral resection of the prostate (pTURP) in the era of taxane chemotherapy and potent androgen receptor antagonists at our tertiary-care institution. METHODS: Using hospital coding data, we identified patients with a diagnosis of prostate cancer who underwent a TURP at Hotel-Dieu Hospital in Quebec City between 2006 and 2016 for detailed chart review. Co-morbidities were classified using the Charlson comorbidity index (CCI). Cox regression analyses assessed predictors of perioperative mortality and morbidity. RESULTS: Of 137 patients identified, 58 were included in our study. Median age was 68 years; 27 (47%) men had castration-resistant prostate cancer and 28 (48%) were metastatic at time of pTURP. Mean follow-up from the first pTURP was 2.2 years, with an estimated 5-year overall survival of 16.3% (95% CI: 6.5%-29.8%). Castration-resistant prostate cancer, CCI ≥5, and age predicted poorer survival. Primary indication for pTURP was bladder outlet obstruction (69%) or hematuria (22%). Postoperative Clavien 0, 1, 2, 3, 4, 5 complications occurred in 20 (34%), 16 (28%), 18 (31%), 3 (5%), 0, and 1 (2%) patients, respectively. Overall, 17 (27%) men underwent ≥1 redo pTURPs and 16 (28%) eventually had an indwelling catheter. Nephrostomy tubes or ureteral stents in place before pTURP remained indefinitely in all cases. CONCLUSIONS: We conclude palliative TURP remains an important surgical option to relieve bladder outlet obstruction in patients with locally advanced prostate cancer, but is ineffective to relieve ureteral obstruction.
BACKGROUND: Advanced prostate cancer may cause significant local complications which affect quality of life, including bladder outlet obstruction and hematuria. We performed a detailed review of our outcomes of palliative transurethral resection of the prostate (pTURP) in the era of taxane chemotherapy and potent androgen receptor antagonists at our tertiary-care institution. METHODS: Using hospital coding data, we identified patients with a diagnosis of prostate cancer who underwent a TURP at Hotel-Dieu Hospital in Quebec City between 2006 and 2016 for detailed chart review. Co-morbidities were classified using the Charlson comorbidity index (CCI). Cox regression analyses assessed predictors of perioperative mortality and morbidity. RESULTS: Of 137 patients identified, 58 were included in our study. Median age was 68 years; 27 (47%) men had castration-resistant prostate cancer and 28 (48%) were metastatic at time of pTURP. Mean follow-up from the first pTURP was 2.2 years, with an estimated 5-year overall survival of 16.3% (95% CI: 6.5%-29.8%). Castration-resistant prostate cancer, CCI ≥5, and age predicted poorer survival. Primary indication for pTURP was bladder outlet obstruction (69%) or hematuria (22%). Postoperative Clavien 0, 1, 2, 3, 4, 5 complications occurred in 20 (34%), 16 (28%), 18 (31%), 3 (5%), 0, and 1 (2%) patients, respectively. Overall, 17 (27%) men underwent ≥1 redo pTURPs and 16 (28%) eventually had an indwelling catheter. Nephrostomy tubes or ureteral stents in place before pTURP remained indefinitely in all cases. CONCLUSIONS: We conclude palliative TURP remains an important surgical option to relieve bladder outlet obstruction in patients with locally advanced prostate cancer, but is ineffective to relieve ureteral obstruction.
Authors: Ghalib Jibara; Daniel D Sjoberg; Gillian L Stearns; Yariv Stabholz; Ali Fathollahi; Laura S Leddy; Nicole Benfante; Behfar Ehdaie; Jonathan A Coleman; James A Eastham; Jaspreet S Sandhu Journal: Urology Date: 2021-02-02 Impact factor: 2.633
Authors: Juan P Rojas-Manrique; Angie Ramírez Ramírez; Luis Miguel Becerra Méndez; Jose G Ramos Ulloa; Carlos Riveros; Rodolfo Varela Ramirez Journal: Cureus Date: 2019-09-24