The correlation of pretreatment transurethral resection of prostatic cancer with tumor dissemination and disease-free survival: A univariate and multivariate analysis

Abstract

A multivariate Cox's hazard function analysis was performed on the prognostic variables selected from 240 patients with localized carcinoma of the prostate who received external beam radiotherapy to analyze the association between the method of biopsy and disease-free survival. The patients received 4500 cGy to the pelvis followed by a 2-week treatment rest and then an additional 2000 cGy to the reduced prostatic volume. Median follow-up was 4 years (range, 1-9 years). The 5-year actuarial local control rate was 91%. There was no difference in local control relative to the method of biopsy (needle biopsy or transurethral resection of the prostate [TURP]). The 5-year actuarial risks of metastases were 28% and 48% for the needle biopsy and TURP groups, respectively (P less than 0.01). The 5-year disease-free survival for the needle biopsy and TURP groups were 55% and 42%, respectively (P less than 0.05). This difference maintained statistical significance for Stage C and Grade III tumors. A multivariate analysis demonstrated that "method of biopsy" was the third most powerful variable after serum acid phosphatase level and modified Broders' grade in predicting disease-free survival. Patients who had TURP had an almost twofold higher relative risk of disease progression than those who had needle biopsy. This study established the correlation of the method of biopsy with a lower probability of disease-free survival over and above the information obtained from the clinical stage, histologic grade, presence or absence of symptoms of obstruction, acid phosphatase level, and lymph node status. The association of TURP with tumor dissemination is discussed with reference to the mechanism of metastasis formation and prevention.

Overview of Benign and Malignant Prostatic Disease in Pakistani Patients: A Clinical and Histopathological Perspective

“…The algothims for additional sampling of TUR specimens were followed (McDowell et al, 1994). Studies have shown that patients in whom carcinoma is discovered in clinically benign TUR specimens have higher rates of tumor dissemination than those diagnosed by needle biopsy because tumors diagnosed incidentally in TUR specimens are usually more advanced (Forman et al, 1986).…”

Biochemical Parameters as Prognostic Factors in Prostatic Adenocarcinoma

“…This may be related to a lowered general condition of the uremic patients or to transurethral resections which were used in treating the urinary outflow obstruction (3). Transurethral resections in turn have been related to an unfavorable prognosis, possibly due to the dissemination of the disease during the surgical procedure (21). Elevated serum levels of ALP in prostatic adenocarcinoma are related to increased bone metabolism due to bone marrow metastasis of the tumour (9)(10)(11)13).…”

Proliferative response of human prostate tumour xenografts to surgical trauma and the transurethral resection of the prostate controversy

“…The method of diagnosis was not prognostically important, however, in patients with stage B disease. A multivariate Cox's hazard function analysis was performed by Forman et al (1986) on the prognostic variables selected from 240 patients with localised carcinoma of the prostate, who received external-beam radiotherapy, to analyse the association between the method of biopsy and disease-free survival. Median follow-up was 4 years.…”

“…The recent report by Zagars et al (1993) (Hanks et al, 1983;Forman et al, 1986;McGowan 1987;Perez et al, 1989;Amdur et al, 1990) but there are reports that such an association does not exist (Anscher and Prosnitz, 1991) Group Figure 3 Inhibiting the trauma-induced accelerated growth of human prostate tumour xenografts by treating the surgical lesion topically with Lanreotide. PC-3 tumour xenografts were implanted s.c. in non-traumatised animals, (group 1; ) and intralesionally in traumatised animals (group 5; 1111), as untreated controls.…”