Objective: To investigate the efficacy of palliative transurethral prostatectomy (TURP) for lower urinary tract symptoms (LUTS) in men with prostate cancer.
Patients and method: The surgical outcome of TURP performed in 46 men with prostate cancer was studied. A poor outcome was defined as the development of urinary incontinence, repeat surgery and placement of a long-term catheter (LTC) within 1 year of surgery. A cohort of 47 men who underwent TURP for benign prostatic hyperplasia (BPH) was used as a control population.
Results: Initial catheter removal failed in a larger number of cancer patients compared to men with BPH (43% and 10%, respectively, P = 0.0001). Using objective endpoints, 37% (17/46) of cancer patients were defined as having a poor outcome because of repeat surgery, placement of a LTC or urinary incontinence following TURP. These events occurred in only 12% (6/47) of the control cohort (P = 0.004). In multiple regression analysis a good outcome was associated with presentation in acute urinary retention (AUR; P = 0.01) while a poor outcome was associated with surgery in the context of hormone refractory disease (P = 0.004). Requirement for a LTC despite surgery (12/46) was also associated with the absence of AUR at presentation (P = 0.01) and hormone refractory disease (P = 0.01).
Conclusion: A significant number of men with prostate cancer and LUTS may not derive a good palliative benefit from TURP. Patients with hormone refractory disease in particular are more likely to have poorer outcomes.