Comparisons of cancer-specific and overall mortality in patients with biopsy- and TURP-diagnosed prostate cancer: a population-based propensity score-matching study

Abstract

This population-based propensity score-matching study aimed to investigate the survival outcomes of patients with biopsy- and transurethral resection of the prostate (TURP)-diagnosed prostate cancer (PC). We obtained data from the Surveillance, Epidemiology and End Results (SEER) database, PC patients diagnosed by biopsy and TURP from 1975 to 2019 were enrolled. Cohort data were baseline-matched using a propensity score-matching (PSM) study. Compared with biopsy-confirmed PC (BPC) patients, prostate cancer-specific mortality (CSM) and overall mortality (OM) in patients with transurethral resection of the prostate (TURP)-diagnosed PC (TPC) were analyzed. A total of 26,027 cases were obtained for this study, of which 4770 cases (18.3%) were TPC patients and 21,257 cases (81.7%) were BPC patients. The proportion of TPC patients showed an increasing trend. The prognosis of TPC patients seemed worse, the ratios of CSM and OM were higher, and the median survival time was shorter (all p < 0.05). After PSM, TPC patients still had a worse prognosis. Compared with BPC patients, TPC patients’ CSM and OM risks increased by 42.0% and 43.0%, respectively (p < 0.001). The results of subgroup analysis indicated earlier the stage of TPC patients, the higher the risk of OM, while systemic treatment after surgery may bring declines of CSM and OM (all p for interaction < 0.001). To our knowledge, we first used a large sample size to find that clinically suspected PC patients with obstruction, directly TURP will increase the risk of CSM and OM.