Crain Donald S, Amling Christopher L, Kane Christopher J
Department of Urology, Naval Medical Center San Diego, California 92134, USA.
J Urol. 2004 Feb;171(2 Pt 1):668-71. doi: 10.1097/01.ju.0000104845.24632.92.
The outcome of patients with advanced prostate cancer undergoing palliative transurethral resection of the prostate (TURP) is not well defined in the literature. We determined the preoperative characteristics, operative morbidity and postoperative outcomes of patients with advanced prostate cancer undergoing palliative TURP and compared these outcomes to those of patients undergoing TURP for benign prostatic hyperplasia (BPH).
A retrospective review of all patients with prostate cancer undergoing palliative TURP at a single institution between 1994 and 2001 was performed. Operative reports, and outpatient and inpatient records were reviewed. Serum prostate specific antigen, and cancer grade and stage at cancer diagnosis were compared with findings at TURP. Operative statistics, postoperative outcomes and complication rates were compared between the palliative prostate cancer TURP group and a large cohort of 520 patients undergoing TURP at our institution for BPH during the same period. The Fisher exact and 1-sample t test were used to determine statistical differences in outcomes between these 2 groups.
A total of 24 palliative TURPs were performed in 19 patients. At prostate cancer diagnosis mean patient age was 68.7 years (range 49 to 87) and median prostate specific antigen +/- SD was 39.7 +/- 78.3 ng/ml (range 1.5 to 334). Radiation therapy was the initial treatment in 11 patients (58%) and the remainder received initial hormonal therapy. Mean age at TURP was 74.2 years (range 50 to 91) with an average time from prostate cancer diagnosis to TURP of 49.7 months (range 1 to 196). While only 22.7% of the patients had high grade cancer (Gleason score 8 to 10) at cancer diagnosis 67% were determined to be high grade at palliative TURP (p = 0.001). After TURP the mean urinary flow rate decreased from 9.6 to 7.3 cc per second (p = 0.453) and the International Prostate Symptom Score improved from 21.1 to 11 (p = 0.002). Compared with patients undergoing TURP for BPH those treated with palliative TURP were more likely to have failure of the initial voiding trial (p <0.001), and require reoperation (p <0.001), chronic drainage (p = 0.001) and re-catheterization for bleeding or obstruction (p = 0.056).
Palliative TURP can be performed safely in patients with advanced prostate cancer with significant improvement in urinary symptoms. However, the rates of postoperative urinary retention and reoperation are higher than in patients undergoing TURP for BPH.
晚期前列腺癌患者接受姑息性经尿道前列腺切除术（TURP）的治疗结果在文献中尚无明确定义。我们确定了接受姑息性TURP的晚期前列腺癌患者的术前特征、手术并发症及术后结果，并将这些结果与因良性前列腺增生（BPH）接受TURP的患者进行比较。
对1994年至2001年间在单一机构接受姑息性TURP的所有前列腺癌患者进行回顾性研究。查阅手术报告、门诊及住院记录。将血清前列腺特异性抗原、癌症诊断时的分级和分期与TURP时的检查结果进行比较。比较姑息性前列腺癌TURP组与同期在我院因BPH接受TURP的520例患者队列的手术统计数据、术后结果及并发症发生率。采用Fisher精确检验和单样本t检验确定两组结果的统计学差异。
19例患者共接受了24次姑息性TURP。前列腺癌诊断时患者平均年龄为68.7岁（范围49至87岁），前列腺特异性抗原中位数±标准差为39.7±78.3 ng/ml（范围1.5至334）。11例患者（58%）初始治疗为放疗，其余患者接受初始激素治疗。TURP时平均年龄为74.2岁（范围50至91岁），从前列腺癌诊断到TURP的平均时间为49.7个月（范围1至196个月）。虽然仅22.7%的患者在癌症诊断时为高级别癌（Gleason评分8至10），但在姑息性TURP时67%的患者被确定为高级别癌（p = 0.001）。TURP后平均尿流率从每秒9.6降至7.3 cc（p = 0.453），国际前列腺症状评分从21.1改善至11（p = 0.002）。与因BPH接受TURP的患者相比，接受姑息性TURP治疗的患者更有可能初始排尿试验失败（p <0.001），需要再次手术（p <0.001）、长期引流（p = 0.001）以及因出血或梗阻再次导尿（p = 0.056）。
晚期前列腺癌患者可安全地接受姑息性TURP，尿路症状有显著改善。然而，术后尿潴留和再次手术的发生率高于因BPH接受TURP的患者。
