989Palliative transurethral resection of the prostate TURP — A consecutive series of 89 patients

PALLIATIVE TRANSURETHRAL RESECTION OF THE T U R P - A C O N S E C U T I V E S E R I E S O F 89 P A T I E N T S

989

990

PROSTATE

T R A N S U R E T H R A L R E S E C T I O N O F P R O S T A T E (TUR-P) I N P A T I E N T S WITH BLADDER OUTLET OBSTRUCTION DUE TO LOCALLY ADVANCED PROSTATE CANCER

Marszalek M., Rauchenwald M., Madersbacher S.

Pertia A=, Nikoleishvili D., Kiknavelidze K., Tchanturaia Z., Managadze L.

Donauspital, Urology and Andrology, Vienna, Austria

National Center of Urology, Oncological Urology, Tbilisi, Georgia

I N T R O D U C T I O N & O B J E C T I V E S : Little is k n o w n regarding the long-term outcome of palliative TURP (pTURP). A i m o f this study was therefore to assess this issue in a contemporary, consecutive series o f patients. M A T E R I A L & M E T H O D S : Retrospective study of all patients who underwent pTURP between 1992 and 2004 at our institution. Patients with incidental prostate cancer ( p T l a / p T l b ) or who underwent p T U R P after brachytherapy were excluded. R E S U L T S : A total of 89 patients entered this study. Median PSA at diagnosis was 20.8 ng/ml (range: 0.7-5000 ng/ml), Gleason score averaged at 7.3 and mean prostate volume was 55 ml. Indications for pTURP were acute urinary retention in 33%, bladder outlet obstruction in 46%, bladder stones in 9.8%, chronic urinary retention in 6%, haematuria in 8.5% and hydronephrosis in 5%. Mean time interval between diagnosis o f PC and pTURP was 19 months, mean age at pTURP was 77 yrs (range: 46-94 yrs). At the time o f pTURP 59% of patients were under endocrine therapy and 12.4% received percutaneous radiotherapy prior to resection. Mean follow-up after pTURP was 3.0 yrs (range: 0.1-14.1 yrs), 11 patients (12.4%) died on PC during follow-up. A 2 ~d pTURP was necessary in 20.7%, 4.6% o f patients underwent 3 or 4 transurethral resections. At the last follow-up visit, spontaneous voiding was possible in 78.7% with a post-voiding residual volume o f less than 100ml in 77.2% of those patients. In the remaining 21.3 % of patients, who required catheterization, the average time interval between diagnosis o f PC and pTURP tended to be shorter (15.8 vs. 19.5 months; p=0.687) and PSA serum levels at time of pTURP to be higher (179.0 ng/ml vs. 86.9 ng/ml; p=0.167) than in spontaneous voiding patients. C O N C L U S I O N S : In patients with locally advanced prostate cancer palliative transurethral resection of the prostate is a safe and effective way of treating bladder outlet obstruction. Further studies will be needed to reveal predictive factors concerning the outcome ofpTURP.

INTRODUCTION & OBJECTIVES: The gold standard for treatment of locally advanced prostate cancer LAPC is well defined: the combination of radiation therapy and hormonal treatment. However some patients develop obstructive voiding due to local growth and TURP is the option. The aim of our study was to evaluate operative and postoperative morbidity and long-term functional results of palliative TUR-P in patients with LAPC. MATERIAL & METHODS: We followed 56 patients with LAPC who underwent palliative TUR-P from 1996 to 2001 and their medical charts were analyzed retrospectively. Operative recording, postoperative morbidity and outcomes were compared between these group of patients and large group of 1177 patients undergoing TURP for BPH at our institution during same period. The X 2 test and 1-sample t test were used to determine statistical differences in operative recordings and outcomes between two groups. RESULTS: Mean follow-up period was 35.6 months (18 to 47 month). 26 out of 56 patients were admitted with urinary retention. 45 patients (80%) were already castrated (Mean time 7.8 months) and 11 patients (20%) underwent castration post-operatively. No patients were irradiated. Mean volume of the prostate was 61.14 cc (range 29 to 105 co). Mean operative time was 39.8 rain. There was no operative mortality. Mean resected weight of the prostate was 24.5 gm. Estimated blood loss was 70 ml. Postoperatively 7 patients (13.3 %) failed to void, 2 patients (3.5 %) was discharged with cystostomy tube, Postoperative uroflowmetry was available in 37 cases, mean Qmax was 9.3 ml/sec (range 4 to 24 ml/sec). During the follow-up period of 12 months re-operation was performed in 9 patients (16 %). Mean time to repeat intervention was 12.4 months (from 3 to 37 months). Endoscopy revealed growth of prostate cancer in all cases. Statistical differences between prostate cancer and BPH groups did not reach statistical differences in terms of operative time (p<0.543), postoperative flowrate (!0<0.031) and estimated blood loss (p<0.045). On the other hand statistical significant differences were detected between two groups in terms of reoperation rate (P<0.05) and initial voiding trial failure (p<0.001). CONCLUSIONS: TURP patients with LAPC are safe procedure in terms of operative and postoperative complications. However functional results (postoperative urinary retention and re-treatment rate) are lower comparing with TURP for BPH patients, though the cause of persistent bladder outlet obstruction is the local growth of the turnout. We can conclude that TURP should be recommended for alleviation of bladder outlet obstruction in properly selected locally advanced prostate cancer patients.

992

991 EFFICACY OF HIGH INTENSITY FOCUSED ULTRASOUND IN THE LOCAL PALLIATIVE TREATMENT OF ADVANCED/SYSTEMIC PROSTATE CANCER

Staedt. Krankenhaus Muenchen Harlaching, Urological Department, Munich, Germany INTRODUCTION & OBJECTIVES: Evaluation of 128 cases of not localized prostate cancer treated by HIFU. 3 Groups hnve been analyzed: Recun-enee after surgery (S), recurrence after radiation (R) and metastatic disease (M). MATERIAL & M E T H O D S : 35 Patients (S), 34 patients (R) and 59 patients (M) with biopsy proven recurrent/primary metastatic PCa have been treated with transrectal HIFU in a single centre using Ablatherm® HIFU (EDAP-HIFU.com). RESULTS: Group distribution, inclusion criteria, staging results, therapy results, additional therapy:

Grouping criteria

M

Number of pat. T

35 4

34 all

59 all

N/M Gleason score'(I-5)

0 all

0 all

t all

no. of+ biops,

all

all

all

PSA i

all

all

% of all patients

3.0 72

all 5.1

age (median)

3.1 70

Grouping

targeted prostatic vol

> 90

> 90

> 80

results

no. of + biops. % Gl.score 4+5

3 67

4 80

4/6 83

prostate vol (cc) potent before HIFU (%)

4 4

I4 18

PSA initially ...Nadir time to Nadir (weeks) ...velocity (ng/year) ... at last PSA

13 0.2 x x 0.3

0.7

32 32 31 / 52 0.15

x 2.6

0.6/16.9 3.3/10.4

neg. biopsies if+, res TU vol.

74 35

53 60

63 70

add. PCa thor. ~plicat. endoOR after HIFU HIFU re Tx (%) FU (weeks) potent after HIFU (%)

50 14 14 0 25/257 0

70 49 31 12 / 0 52/150

100 3.1 22 11 102/132

PSA (ng/ml)

66

7.4/2.7

10

CONCLUSIONS: H 1 F U i n recurrentPCa is a feasible option for local therapy. It coagulates local tumour and delays hormonal ablation. The application of H l F U i n metastatic disease with destruction of the local tumour, including the othei~vise untreated "non hormone sensitive" PCa cells, results in a reduction of local morbidity (supra-/infravesical obsmtction, ureter stentthg, bleeding, pain), an increase of somatic and psychological QoL and longer survival time.

European Urology Supplements 4 (2005) No. 3, pp. 250

FOR

LOCALIZATION

OF

Martorana G. t, Schiavina R. ~, Brunocilla E. t, Bertaccini A. j, Manferrari F?, Franceschelli A. 1, Martinelli A. 1, Franchi R.2, Monetti N. 2, Castellucci E 2, Farsad M?, Fanti S. 2, Grigioni W . E 3, C o r t i B ? , Fiorentino M . 3, D'Errico A )

Chaussv C., Thueroff S., Buehrend H., Knauer K.

Patient groups

ll-C-CHOLINE PET/CT IMAGING RECURRENT PROSTATE CANCER

lOspedale Sant' Orsola Malpighi, Alma Mater Studiorum, University of Bologna, Department of Urology, Bologna, Italy, 2Ospedale Sant' Orsola Malpighi, Pet Center, Nuclear Medicine, Bologna, Italy, 3Ospedale Sant' Orsola Malpighi, Alma Mater Studiorum University of Bologna, Department of Oncology and Haematology, "Felice Addari " Institute, Bologna, Italy INTRODUCTION & OBJECTIVES: A significant percentage of patients (pts) treated with radical prostatectomy for localized prostate cancer will develop recurrent disease. We studied the effectiveness of 11-C-Choline PET/CT imaging (PET-TC) in the detecting of local recurrence or distant metastases in pts with early or late PSA relapse after radical prostatectomy in comparison with conventional imaging findings. MATERIAL & M E T H O D S : We reviewed 83 pts treated with radical prostatectomy (mean age: 66 yrs; range: 52 - 83 yrs) with mean PSA relapse of 7.6 ng/ml (range 0.2-84 ng/ml). All pts underwent diagnostic evaluation for local or distant recurrence with PET/TC, digital rectal examination (DRE), transrectal ultrasonography (TRUS), bone scan, RM or TC. Perianastomotic biopsy was performed only in case of suspected local recurrence. Hormonal treatment was avoided or interrupted within 2 months before PET/TC study. PET/CT studies were carried out 5 min after i.v. administration of approximately 400 MBq 11-C-Choline using a PET/CT scanner (GE Discovery LS). RESULTS: Conventional imaging (DRE, TRUS, biopsy, RM, TC, bone scan) were globally positive in 43 pts and negative in 40 pts. PET/CT was positive in 41 pts and negative in 42 pts. Conventional imaging and PET/TC were concordants in identification of at least one site of recurrence in 33 pts. PET/CT study demonstrated local recurrence in 7/41 pts (4 cases suspected by TRUS and RM and 2 case confirmed by biopsy), bone lesions in 13/41 (11 cases suspected by bone scan), nodal metastases in 12/41 (5 pelvic, 4 iliac, 1 lombo-aortic and 2 iliac and lombo-aortic lymph nodes; 9 cases suspected by RM or TC) and both bone lesion and multiple nodal involvement in 9/41 (6 cases confirmed by bone scan, 3 cases by RM). CONCLUSIONS: In our study ll-C-Choline PET/CT succeeded in identifying site of metastases of recurrent prostate cancer in 41/83 pts (49%), with one step exam; similar result (43/83 pts, 51%) was obtained with combined conventional imaging. These preliminary results suggest the additional value of 1I-C-Choline PET/CT to detect local recurrences or distant metastases. Use of PET/CT fused images provided more comfortable identification of metastatic lesions, particularly lymph nodes. No definitive correlation was found between PSA values and PET/CT results but better detection rate was found in pts with higher level of PSA relapse, with 73% of positive PET/TC in pts with PSA > 5 ng/ml.