IMPACT OF TRANSURETHRAL RESECTION ON THE LONG-TERM OUTCOME OF PATIENTS WITH PROSTATIC-CARCINOMA

Between March 1970 and December 1987, 1,078 patients with adenocarcino ma of the prostate were treated with pelvic lymph node dissection and permanent iodine-125 implantation. Before implantation, 257 patients ( 27%) underwent transurethral resection of the prostate, while 702 (73% ) did not and their diagnosis was established by needle biopsy. A tota l of 119 patients (10%) underwent hormonal therapy before implantation and they were excluded from the present analysis. Clinical stage and pathological grade were similar in both groups. A higher percentage of patients in the transurethral resection group had nodal metastases at implantation. Positive lymph nodes were found in 121 patients (47%) i n the transurethral resection group versus 199 (26%) who did not under go resection (p <0.001). The actuarial 5, 10 and 15-year distant metas tasis-free survival rates among the patients who underwent transurethr al resection of the prostate were 79%, 42% and 16%, respectively, comp ared to 86%, 52% and 27%, respectively, in the group without transuret hral resection (p <0.0001). Similarly, the actuarial disease-free and local relapse-free survival rates were significantly inferior in the t ransurethral resection group. A negative impact of transurethral resec tion of the prostate could be demonstrated among patients with grade I /II tumors. However, when stratified for nodal status, no difference i n outcome in any clinical parameter was noted between the groups with and without transurethral resection of the prostate. Specifically, dis tant metastasis-free survival among transurethral resection group pati ents with negative nodes was 78%, 57% and 47% at 5, 10 and 15 years, r espectively, compared to 80%, 59% and 47%, respectively, among the pat ients with negative nodes who did not undergo transurethral resection of the prostate (p = 0.38). Similarly, the differences between the 2 g roups among patients with positive lymph nodes were not significant. W hen stratified by the clinical stage, grade and nodal status, the nega tive impact of transurethral resection of the prostate could not be de monstrated in any combination. A multivariate analysis failed to demon strate transurethral resection of the prostate to be an independent va riable in predicting the metastatic, local control or disease-free sur vival outcome. In conclusion, the long-term results in these pathologi cally staged cases indicate that transurethral resection of the prosta te does not impact negatively on the clinical outcome.