Tumor cytoreduction results in better response to androgen ablation—a preliminary report of palliative transurethral resection of the prostate in metastatic hormone sensitive prostate cancer

Qin, Xiao-Jian; Ma, Chun-Guang; Ye, Ding-Wei; Yao, Xu-Dong; Zhang, Shi-Lin; Dai, Bo; Zhang, Hai-Liang; Shen, Yi-Jun; Zhu, Yao; Zhu, Yi-Ping; Shi, Guo-Hai; Xiao, Wen-Jun; Lin, Guo-Wen; Swanson, Gregory P.

doi:10.1016/j.urolonc.2010.02.010

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Tumor cytoreduction results in better response to androgen ablation—a preliminary report of palliative transurethral resection of the prostate in metastatic hormone sensitive prostate cancer

Xiao-Jian Qin, M.D.
- Department of Urology, Fudan University Shanghai Cancer Centre, Shanghai, China
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
Chun-Guang Ma, M.D.
- Department of Urology, Fudan University Shanghai Cancer Centre, Shanghai, China
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
Ding-Wei Ye, M.D.
- Department of Urology, Fudan University Shanghai Cancer Centre, Shanghai, China
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
- Corresponding author. Tel.: +862164175590; fax: +862164175590
Xu-Dong Yao, M.D.
- Department of Urology, Fudan University Shanghai Cancer Centre, Shanghai, China
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
Shi-Lin Zhang, M.D.
- Department of Urology, Fudan University Shanghai Cancer Centre, Shanghai, China
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
Bo Dai, M.D.
- Department of Urology, Fudan University Shanghai Cancer Centre, Shanghai, China
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
Hai-Liang Zhang, M.D.
- Department of Urology, Fudan University Shanghai Cancer Centre, Shanghai, China
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
Yi-Jun Shen, M.D.
- Department of Urology, Fudan University Shanghai Cancer Centre, Shanghai, China
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
Yao Zhu, M.D.
- Department of Urology, Fudan University Shanghai Cancer Centre, Shanghai, China
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
Yi-Ping Zhu, M.D.
- Department of Urology, Fudan University Shanghai Cancer Centre, Shanghai, China
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
Guo-Hai Shi, M.D.
- Department of Urology, Fudan University Shanghai Cancer Centre, Shanghai, China
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
Wen-Jun Xiao, M.D.
- Department of Urology, Fudan University Shanghai Cancer Centre, Shanghai, China
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
Guo-Wen Lin, M.D.
- Department of Urology, Fudan University Shanghai Cancer Centre, Shanghai, China
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
Gregory P. Swanson, M.D.
- Department of Radiology and Urology, University of Texas Health Science Center, San Antonio, TX 78229, USA

Received 2 November 2009; received in revised form 6 February 2010; accepted 10 February 2010. published online 10 May 2010.
Corrected Proof

Abstract

Objectives

To investigate the oncologic influence of transurethral resection of the prostate (TURP) as a cytoreductive surgery in metastatic hormone sensitive prostate cancer (mHSPC), in the setting of continuous complete androgen blockade (CAB).

Materials and methods

Medical histories of 146 consecutive Chinese males with newly diagnosed mHSPC, registered in our institution in 2006 and 2007, were reviewed. All of these patients received CAB as initial systematic therapy. Demographics and cancer control outcomes from 39 mHSPC patients who underwent TURP for a relief of bladder outlet obstruction were compared with those of the other 107 who received CAB only when they were still hormone-sensitive. Median follow-up was 15 months (3 to 27 months).

Results

Age at diagnosis, baseline PSA, and biopsy Gleason score were comparable between the 2 groups. Patients who underwent a TURP had lower PSA nadir (median 0.15 ng/ml vs. 0.82 ng/ml, P = 0.015) and longer time to PSA nadir (11.2 months vs. 6.4 months, P < 0.001). More patients in the non-TURP group developed hormone refractory prostate cancer (P = 0.007). The TURP group had a tendency towards longer disease-specific survival and overall survival (24.4 months vs. 24.1 months and 24.4 months vs. 22.9 months, respectively), though this did not reach statistical significance.

Conclusions

TURP resulted in a better and more prolonged response to hormone therapy in mHSPC, with a trend towards positive influence in disease specific survival and overall survival. To date, our preliminary report is the first study regarding long-term survival of cytoreductive surgery in mHSPC, and further investigations are warranted.

Keywords: Cytoreductive surgery, Hormone sensitive metastatic prostate cancer, Hormone therapy, Prognosis, Transurethral resection of the prostate