Palliative transurethral resection of the prostate: functional outcome and impact on survival

To assess the long-term functional and oncological outcome in a consecutive series of patients undergoing palliative transurethral resection of the prostate (pTURP).

We retrospectively assessed all patients who had a pTURP between 1992 and 2004 at our institution. Patients with incidental prostate cancer (pT1a/pT1b) were excluded. In all, 89 patients (mean age 75.9 years, sd 0.9, at diagnosis) entered the study.

The median (range) prostate-specific antigen level at diagnosis was 25.7 (0.7-5000) ng/mL and the mean Gleason score was 7. The mean (sd, range) interval between the diagnosis of prostate cancer and pTURP was 1.5 (0.3, 0.5-10.9) years. The indications for pTURP were refractory urinary retention in 30%, severe bladder outlet obstruction with a postvoid residual urine volume of > 100 mL in 43%, and bladder stones, haematuria and hydronephrosis in 9% each. The mean (sd, range) follow-up after pTURP was 2.6 (0.2, 0.1-7.3) years. The peri-operative mortality (<30 days) was 2%, and 22 patients (25%) died during the follow-up. As estimated by Kaplan-Meier analysis, the 1-, 2- and 5-year survival rates were 83%, 70% and 61%, respectively. Patients with prostate cancer in the pTURP specimen had a shorter 3-year survival (52%) than those with a negative histology (89%, P = 0.03). At the last follow-up, 79% of men voided spontaneously and were continent. A repeat pTURP was necessary in 25% of patients, 11% required permanent catheterization and 10% were incontinent.

Despite greater peri-operative mortality and morbidity than conventional TURP, pTURP is a fairly safe and effective procedure. Although a potential negative impact of pTURP on survival cannot be excluded, the estimated 5-year survival of 61% in this series seems to justify this intervention.