EFFECT OF TRANSURETHRAL RESECTION OF PROSTATE (TURP) ON PROGRESSION TIME IN PATIENTS WITH ADVANCED PROSTATE CANCER RECEIVING MAXIMUM ANDROGEN BLOCKADE

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 difference 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.