Can the need for palliative transurethral prostatic resection in patients with advanced carcinoma of the prostate be predicted?

PURPOSE: To identify the factors predicting the need for palliative transurethral resection of the prostate (channel TURP) in patients with advanced carcinoma of the prostate (CAP) receiving androgen ablation therapy.

PATIENTS AND

METHODS

From January 1996 to January 2004, 203 patients with advanced CAP were treated by androgen ablation. Patients presenting with retention were catheterized initially, and those (N = 12) who failed a catheter-free trial and had immediate channel TURP were excluded. The remaining 191 patients were followed every 3 months (mean 35.5 months, range 6-92 months). Patients requiring channel TURP (group 1; N = 42 [22%]) during follow-up were compared with those who did not (group 2) for predictive factors, viz. retention of urine, serum prostate specific antigen (PSA) concentration, Gleason sum, prostate size, and bony metastasis at presentation.

RESULTS

Channel TURP was performed at a mean of 21 months (range 3-72 months). The mean Gleason sum in this group was 7.88, whereas it was 7.29 in group 2 (P = 0.013). Retention at presentation was significantly more common in group 1 (N = 26; 61.9%) than in group 2 (N = 46; 30.8%; P = 0.001). Patients who did not present with retention and had Gleason sums < or =7 (N = 32) did not require channel TURP. Of the 14 patients who voided successfully after a catheter-free trial but had Gleason sums of >7, 71.4% required channel TURP. Other factors were not found to be significantly different in the two groups.

CONCLUSION

High Gleason sum and retention at presentation are significant factors predictors of the need for channel TURP during follow-up in patients with advanced CAP receiving androgen ablation therapy.