The relationship of palliative transurethral resection of the prostate with disease progression in patients with prostate cancer

Study Type – Prognosis (exception cohort) Level of Evidence 1b OBJECTIVES To test, in a prostate‐cancer population‐based database, the validity of the finding that in single‐institution series, palliative transurethral resection of prostate (TURP) is associated with an increased risk of progression. PATIENTS AND METHODS Using the Surveillance Epidemiology and END Results Registry, we identified men who had a TURP subsequent to their diagnosis of prostate cancer, from 1998 or 1999. The outcome of interest was disease progression, as defined by the initiation of androgen‐deprivation therapy or procedures indicating progressive urinary obstruction. Multivariable logistic regression analysis was used to assess the adjusted odds of signal events related to disease progression adjusting for the concurrent effect of the covariates. RESULTS There were 29 361 men with prostate cancer and 2742 (9.3%) had a TURP after the diagnosis. These men had a mean age of 75 years and were unlikely to undergo definitive primary treatment. Men receiving TURP were more likely to undergo orchidectomy than men who did not have a TURP (odds ratio 1.64; 95% confidence interval 1.03–2.60) even after adjusting for differences in cancer‐directed treatment, tumour stage and grade, prostate‐specific antigen level, race, and age at diagnosis. These men were also more likely to have malignant urinary obstruction (ureteric and bladder outlet) than were men who did not have TURP. CONCLUSION The requirement for TURP is an adverse prognostic marker even when this is adjusted for classical tumour characteristics. Although the exact reasons for this finding are unclear, consideration should be given to adjuvant treatment in patients undergoing TURP.