진행성 전립선 암환자에서 고식적 경요도전립선절제술의 효용성 (Palliative Transurethral Resection of Prostate for Bladder Outlet Obstruction in Patients with Advanced Prostate cancer)

서지정보

· 발행기관 : 고신대학교(의대) 고신대학교 의과대학 학술지
· 수록지 정보 : 고신대학교 의과대학 학술지 / 22권 / 1호 / 201 ~ 205페이지
· 저자명 : 김성주, 김한석, 정재민, 최성

초록

Background: The outcome of patients with advanced prostate cancer underwent palliative transurethral resection of the prostate (TURP) is not well defined in the literature. We determined the preoperative characteristics, operative morbidity and postoperative otucomes of patients with advanced prostate cancer underwent palliative TURP and compared these outcomes to those of patinets underwent TURP for benign prostatic hyperplasia (BPH).
Methods ： A retrospective review of all patients with advanced prostate cancer underwent palliative TURP between March 2004 and December 2006 was performed. Operative reports and medical records were reviewed. Serum prostate specific antigen grade and stage at diagnosis were compared with findings at TURP. Operative statistics, postoperative outcomes and complication rates were compared between the palliative prostate cancer group and a cohort of 54 patients underwent TURP for BPH group during the same period. The Fisher exact and 1-sample t test were used to determine statistical differences in outcomes between these 2 groups.
Results - A total of 21 palliative TUHPs were performed in 19 patients with advanced prostate cancer.
At prostate cancer diagnosis, mean patient age was 68.0 years (48-77) and mean prostate specific antigen was 32.8ng/ml (1.9-299). Initial hormonal therapy was done in all patients. Mean age at TURP was 72.1 years (48-79) with an average time from prostate cancer diagnosis to at TURP was 8.3 months (1-25 months). Five (35.7%) patients out of 14 who were confirmed by histology were determined to be higher grade at palliative TURP than at initial diagnosis. The mean maximum uroflow rate increased from 7.3 to 9.6 per second (p<0.05) and the International Prostate Symptom Score improved from 22 to 10 (p<0.05) after TURP. Compared with patients underwent TURP for BPH, those treated with palliative TURP were more likely to have failure of the initial voiding trial (p<0.05)，and require reoperation (p<0.05), chronic drainage (p<0.05) and re~catheterization for bleeding or obstruction (p〈0.05).
Conclusions : Palliative TURP can be performed safely in patients with advanced prostate cancer with significant improvement in urinary symptoms. However, the rates of postoperative urinary retention and reoperation of palliative TURP were higher than in patients undergoing TURP for BPH.

영어초록

Background: The outcome of patients with advanced prostate cancer underwent palliative transurethral resection of the prostate (TURP) is not well defined in the literature. We determined the preoperative characteristics, operative morbidity and postoperative otucomes of patients with advanced prostate cancer underwent palliative TURP and compared these outcomes to those of patinets underwent TURP for benign prostatic hyperplasia (BPH).
Methods ： A retrospective review of all patients with advanced prostate cancer underwent palliative TURP between March 2004 and December 2006 was performed. Operative reports and medical records were reviewed. Serum prostate specific antigen grade and stage at diagnosis were compared with findings at TURP. Operative statistics, postoperative outcomes and complication rates were compared between the palliative prostate cancer group and a cohort of 54 patients underwent TURP for BPH group during the same period. The Fisher exact and 1-sample t test were used to determine statistical differences in outcomes between these 2 groups.
Results - A total of 21 palliative TUHPs were performed in 19 patients with advanced prostate cancer.
At prostate cancer diagnosis, mean patient age was 68.0 years (48-77) and mean prostate specific antigen was 32.8ng/ml (1.9-299). Initial hormonal therapy was done in all patients. Mean age at TURP was 72.1 years (48-79) with an average time from prostate cancer diagnosis to at TURP was 8.3 months (1-25 months). Five (35.7%) patients out of 14 who were confirmed by histology were determined to be higher grade at palliative TURP than at initial diagnosis. The mean maximum uroflow rate increased from 7.3 to 9.6 per second (p<0.05) and the International Prostate Symptom Score improved from 22 to 10 (p<0.05) after TURP. Compared with patients underwent TURP for BPH, those treated with palliative TURP were more likely to have failure of the initial voiding trial (p<0.05)，and require reoperation (p<0.05), chronic drainage (p<0.05) and re~catheterization for bleeding or obstruction (p〈0.05).
Conclusions : Palliative TURP can be performed safely in patients with advanced prostate cancer with significant improvement in urinary symptoms. However, the rates of postoperative urinary retention and reoperation of palliative TURP were higher than in patients undergoing TURP for BPH.

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