PROGNOSTIC IMPACT OF TRANSURETHRAL RESECTION ON PATIENTS IRRADIATED FOR LOCALIZED PROSTATE-CANCER

The prognosis for irradiated patients with localized prostatic carcino ma following transurethral resection of the prostate (TURF) has been d ebated, Controversy centers upon whether or not TURF has an adverse ef fect on the outcome. A retrospective analysis of 264 patients treated during 1974-1991 with radical external beam radiotherapy was performed . Ten patients who were irradiated postoperatively were excluded. One hundred and nine patients with urinary obstruction underwent TURF. In another 155 patients, pathological diagnosis was made by needle aspira tion or tru-cut biopsies. One hundred and one patients received endocr ine manipulation, 58 (40%) in the needle biopsy group, and 43 (39.5%) in the TURF group,lymph node staging by pelvic lymphadenectomy (20 cas es), lymphangiography(15 cases), and CAT and/or NMR (113 cases) was pe rformed in 148 patients. Nodal metastases were found in 38 patients, 1 9 in the needle biopsy group, and 19 in the TURF group. Disease-relate d, disease-free and metastasis-free survivals were calculated for all stages and within each tumor stage and histological grade for both gro ups. Correlation of pretreatment factors with clinical outcome was eva luated by multivariate analysis. Overall, disease-related survival was significantly higher (P = 0.05) in patients undergoing needle biopsy than in those who had TURF (58% vs. 38% at 10 years). This difference was more significant in the subset of patients with well differentiate d tumors (P < 0.01). However, no difference could be observed between the two groups in histological grade 2 and 3 tumors or by stage compar ison. This finding was confirmed by disease-free and metastasis-free s urvival, although the evidence of a better metastasis-free survival in the needle biopsy group was limited to the subset of patients with we ll differentiated and early stage tumors (T1-2), When patients who had been staged for pelvic node involvement were separately analyzed and stratified for nodal status, no differences in any clinical endpoint c ould be demonstrated. Furthermore, univariate analysis revealed that e ndocrine therapy and TURF were not significant prognostic parameters. The most important variable shown by the multivariate analysis was T-s tage in the general patient population, and nodal status in the subset of patients undergoing lymph node staging. Although definitive answer s may be provided only by appropriate clinical trials, there is ample evidence from this series that prior TURF has no effect on disease out come of patients irradiated for prostate cancer localized to the pelvi s.