Management of Localized Prostate Cancer by Focal Transurethral Resection of Prostate Cancer: An Application of Radical TUR-PCa to Focal Therapy

Abstract

Background. We analyzed radical TUR-PCa against localized prostate cancer. Patients and Methods. Seventy-nine out of 209 patients with prostate cancer in one lobe were studied. Patients' age ranged from 58 to 91 years and preoperative PSA, 0.70 to 17.30 ng/mL. In other 16 additional patients we performed focal TUR-PCa. Patients' age ranged from 51 to 87 years and preoperative PSA, 1.51 to 25.74 ng/mL. Results. PSA failure in radical TUR-PCa was 5.1% during the mean follow-up period of 58.9 months. The actuarial biochemical non-recurrence rate was 98.2% for pT2a and 90.5% for pT2b. Bladder neck contracture occurred in 28 patients (35.4%). In 209 patients, pathological study revealed prostate cancer of the peripheral zone near the neurovascular bundle bilaterally in 25%, unilaterally in 39% and no cancer bilaterally in 35%, suggesting the possibility of focal TUR-PCa. Postoperative PSA of 16 patients treated by focal TUR-PCa was stable between 0.007 and 0.406 ng/mL at 24.2 months' follow-up. No patients suffered from urinary incontinence. Bladder neck contracture developed in only 1 patient and all 5 patients underwent nerve-preserving TUR-PCa did not show erectile dysfunction. Conclusion. Focal TUR-PCa was considered to be a promising option among focal therapies against localized prostate cancer.

Radical Transurethral Resection for Prostate Cancer Might Affect the Disputes about Prostate-Specific Antigen Screening: Suggestions Obtained from Radical Transurethral Surgery

“…Urinary incontinence was not observed in the present study. Erectile function was not reserved in some of the patients, but it might be resolved by nerve-sparing TUR-PCa that we reported as an option of focal therapy (Morita & Matsuura, 2012). The most frequent postoperative complication was bladder neck contracture that occurred in 33.0% of patients 3 to 4 months after surgery (Grade IIIa by Clavien classification).…”

“…Less invasive procedures might justify PSA screening and end the dispute of overdiagnosis and overtreatment. We reported radical transurethral resection of prostate cancer (RTUR-PCa) for localized prostate cancer (Morita & Matsuura, 2009;, and we applied it to focal transurethral resection of prostate cancer (FTUR-PCa) as a focal therapy to seek better functional outcomes (Morita & Matsuura, 2012). The idea of a transurethral approach to resect almost total prostate tissues containing PCa dates back to around 1990 (Valdivia Uría & López López, 1989;Reuter, Reuter, & Epple, 1991), and the technique did not significantly increase the operative morbidity and mortality compared with transurethral resection of the prostate (TURP) for benign prostate hyperplasia (BPH).…”

P068 Bipolar plasma vaporization in prostate cancer related urinary retention – a palliative modality of maintaining long term spontaneous voiding

“…The respective type of approach was underlined as a potential option of PCa focal therapy with minimum adverse effects on urinary continence and erectile function [ 15 ].…”

Can Transurethral Resection of the Prostate (TURP) Be Another Gateway to the Focal Therapy of Localized Prostate Cancer?

“…18 We then proposed, as a focal therapy, the possibility of focal TURPCa by applying the technique of radical TURPCa. 19 We would like to report our results of focal TURPCa, namely the results of radical transurethral resection of cancer foci based on the rough cancer mapping obtained from prostate biopsy.…”