Analysis of the possibility that transurethral resection promotes metastasis in prostate cancer

The issue of transurethral resection (TURP) in patients with known prostatic adenocarcinoma is a current clinical controversy. Data have accumulated to associate this procedure with an adverse risk of distant spread and death for a defined subset of patients with moderate and poorly differentiated, T3 and T4 (Stage C) tumors. Review of available literature demonstrates that examination of this subset is incomplete in studies that do not find an adverse prognosis. The reason for the association of TURP and metastasis may be related directly to the resection via mechanical dissemination of tumor or indirectly through association with unknown adverse factors. Retrospective review may be unable to separate these two hypotheses, but hazard function analysis is presented and is consistent with surgical enhancement of metastases. Strategies for avoiding the adverse effect represent areas for possible further clinical research.