Journals / Türk Üroloji Dergisi/Turkish Journal of Urology / 2005 / Cilt: 31 - Sayı: 4
Effect of transurethral resection of prostate (TURP) on progression time in patients with advanced prostate cancer receiving maximum androgen
- Pages
- 474–478
- DOI
- —
Abstract
Introduction: Thirty-thirty five percent of prostate cancer (PCA) patients present with advanced or metastatic stage at the time of diagnosis. One of the frequent surgical procedures applied to patients with prostate cancer, who present with serious lower urinary system findings, is transuretheral prostate resection (TURP) with the purpose of removing the obstruction. Finding tumoral cells in venous system after this surgery had caused questioning of the possible effects of TURP on the invasion and progression of PCA. Herein, we investigated the effect of TURP on progression in patients with advanced prostate cancer. Materials and Methods: Between July 1997 and June 2003, 59 patients with advanced prostate cancer who showed progression were included in this study. 41 of them had undergone TURP and received maximum androgen blockade (MAB) while 18 of them had only received MAB. Progression criteria were accepted as increase in serum prostate specific antigen (PSA) levels on 3 subsequent measurements, increase in number of metastases on bone sintigraphy, growth in visceral masses and worsening of symptoms. Two groups were compared in accordance to mean age, PSA levels, Gleason scores and progression times. For statistical analysis, Student\'s t test was used and p values <0.05 were considered statistically significant. Results: In 41 patients who had undergone TURP and received MAB mean age was 71.4±6.1 years, mean PSA level was 58.2±44.9 ng/ml, mean Gleason score was 7.5±1.8 and the meantime to progression was found as 19.43±10.9 months while in patients who only received MAB, mean age, mean PSA level mean Gleason score and meantime to progression were found as 72.55±8.4 years, 78.9±44.8 ng/ml, 6.4±2.1 and 14.7±10.5 months, respectively. Statistically no significant difference was found in mean age, PSA levels, Gleason scores between the two groups (p=0.549, p=0.112 and p=0.08 respectively). The average follow-up period in TURP+MAB group was 52.15±29.8 months, and 49.32±25.7 months in only MAB group; and no statistically significant differences were found between these periods. Periods till progression were found to be 19.43±10.9 and 14.7±10.5 months, respectively for first and second groups. We found that there was not a statistically significant diffe1- Malkowicz SB: Management of superficial bladder cancer. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, editors.rence in terms of progression time between patients that only MAB was applied, and patients that MAB+TURP was applied (p=0.127). All the patients were regularly followed monthly with androgen withdrawal after progression, and they were included in either antiandrogene change (27 patients; 45.76%) and/or chemotherapy (5 patients; 8.47%) protocols. Conclusion: In our retrospective study, TURP had no effect on cancer progression in patients with advanced prostate cancer. So, in patients with severe lower urinary tract symptoms, TURP can be considered to relieve these symptoms rapidly.
Özet
Prostat kanserli hastaların %30-35\'i ileri evre veya metastatik evrede ve bunların bir kısmı da ciddi alt üriner sistem şikayetleri ile başvurmaktadır. Bu çalışmada, semptomatik ileri evre prostat kanserli hastalara uygulanabilecek transüretral prostat rezeksiyonunun (TURP), kanser seyrine etkisinin olup olmadığını retrospektif olarak araştırmak amaçlanmıştır. Temmuz 1997- Haziran 2003 tarihleri arasında, ilerleme gözlenmiş 59 ileri evre prostat kanserli hasta çalışmaya alındı. Hastaların 41\'i TURP operasyonu geçirmiş, 18\'i yalnızca maksimal androjen blokajı (MAB) almıştır. Progresyon kriterleri; PSA\'da 3 kez %50\'den fazla artma, kemik sintigrafisinde metastazlarda artma, kitlede büyüme, semptomlarda artma olarak kabul edildi. Her iki grup, PSA düzeyleri, yaş ortalamaları, Gleason skorları ve progresyon süreleri yönünden karşılaştırıldı. İstatistiksel analiz olarak Student\'s t testi kullanıldı ve p<0.05 değerleri anlamlı kabul edildi. MAB+TURP uygulanmış olan 41 hastanın yaş ortalaması 71.4±6.1 yıl, PSA düzeyleri ortalaması 58.2±44.9 ng/ml, Gleason skor ortalaması 7.5±1.8 ve progresyon sürelerinin ortalaması 19.43±10.9 ay bulundu. Yalnız MAB uygulanan grubun yaş ortalaması 72.5±8.4 yıl, serum PSA düzeyleri 78.9±44.8 ng/ml, Gleason skorlarının ortalaması 6.4±2.1, progresyona kadar geçen sürelerin ortalaması ise 14.7±10.5 ay olarak tespit edildi. Gruplar arasında yaş, PSA düzeyleri, Gleason skorları ve progresyona kadar geçen süreler açısından istatistiksel fark olmadığı gözlendi (sırasıyla p=0,549, p=0,112, p=0,08 ve p=0,127). Retrospektif çalışmamıza göre, ileri evre prostat kanseri bulunan hastalarda, TURP\'nun kanser progresyon zamanına etkisi bulunmamaktadır. Bu nedenle, ciddi alt üriner sistem semptomları ile başvuran hastalara, semptomların hızla düzeltilebilmesi nedeniyle TURP önerilebilir.