Initial Transurethral Resection Research Articles

Incidental Carcinoma of the Prostate: Significance of Staging Transurethral Resection

We compared the results of staging by a second circumferential transurethral resection and/or transperineal needle biopsy in 42 patients with stage A prostatic adenocarcinoma on initial transurethral resection (defined as tumor of low grade, Gleason sum 2 to 4, and low volume, less than 5 per cent of the specimen or less than 3 foci). Transurethral resection only was done in 16 patients, transperineal needle biopsy only in 2 and both procedures in 24. In the 24 patients who underwent both procedures residual carcinoma was identified by transurethral resection in 6 and confirmed by transperineal needle biopsy in only 1.Thirty-two patients (76 per cent) had no residual carcinoma. Of the 10 patients (24 per cent) with residual carcinoma 5 underwent radical prostatectomy with pelvic lymphadenectomy, 1 had interstitial irradiation with pelvic lymphadenectomy and 1 had pelvic lymphadenectomy only. No lymphatic metastases were detected; persistent carcinoma confined to the prostate was noted in all 5 patients who had undergone radical prostatectomy and 3 of these tumors were upstaged because of higher grade and/or volume.We conclude that residual carcinoma cannot be assessed accurately with transperineal needle biopsy, whereas transurethral resection staging enabled us to define a substantial number of our patients (24 per cent) with persistent disease. Importantly, upstaging by either low volume/high grade or high volume carcinoma was identified in 3 patients at the time of radical prostatectomy. However, the true stage and prognosis of those patients with persistent low volume and low grade prostatic carcinoma remain to be determined.

Urethral obstruction secondary to carcinoma of prostate: Response to endocrine treatment

Of 749 patients with carcinoma of the prostate 133 (17.8%) presented with total urinary retention; 122 of the 133 patients were given different forms of endocrine therapy. Only 8 patients were treated by initial transurethral resection of the prostate, and 3 patients received no treatment. After endocrine therapy 80 (65.6 %) of 122 patients were free from catheter six months after starting treatment. The response to orchidectomy appeared earlier than that to treatment with estrogens. The mean period of catheterization for the 80 patients who responded was 2.7 months after orchidectomy and 3.4 months during estrogen treatment. The difference was statistically significant (p < 0.05).

Accuracy of staging in A1 carcinoma of the prostate.

The classification of patients with incidental carcinoma of the prostate into focal (Stage A1) or diffuse (Stage A2) subgroups depends primarily on the microscopic findings on tissue removed from transurethral resection (TUR) or open enucleation. However, these procedures sample only a portion of the entire prostate, and some patients staged A1 may have residual diffuse cancer that should properly be classified as Stage A2. This study is a review of 86 patients with Stage A1 cancer of the prostate in whom additional prostatic tissue was available because of repeat transurethral resection or radical prostatectomy. Only six patients (7%) were found to have diffuse cancer in the remaining prostatic tissue. Therefore, it appears that the classification of patients into Stage A1 or Stage A2 is generally accurate when based on the findings from initial TUR alone and that the incidence of understaging in this group is low. Repeat transurethral resection does not appear to contribute significantly to the accuracy of staging.

A Trial of Adjuvant Chemotherapy for Stage T3 Bladder Tumors

A total of 12 patients with stage T3 bladder tumors entered a pilot study of adjuvant chemotherapy with doxorubicin and 5-fiuorouracil after initial transurethral resection and before radiotherapy. Morbidity was minimal and mortality did not seem to be improved compared to a control group.

Paraganglioma of bladder with recurrence ten years later

A paraganglioma (pheochromocytoma) of the bladder recurred ten years after initial transurethral resection. This case demonstrates principles regarding diagnosis, malignancy potential, and treatment of this rare neoplasm.