Evidence on the outcomes of simultaneous transurethral resection of bladder tumor (TURB) for bladder cancer and transurethral resection of the prostate (TURP) for obstructive benign prostatic hyperplasia is limited and contradictory. The aim of this study was to determine the oncological impact and adverse events of performing simultaneous TURB and TURP.
Patients from twelve European hospitals treated with either TURB alone or simultaneous TURB and TURP (TURB+TURP) were retrospectively analyzed. A propensity-score matching (PSM) 1:1 was performed with patients from the TURB+TURP group matched to TURB-alone patients. Associations between surgery approach with recurrence-free (RFS) and progression-free (PFS) survivals were assessed in Cox regression models before and after PSM. We performed a subgroup analysis in patients with risk factors for recurrence (multifocality and/or tumor size >3cm).
A total of 762 men were included, among whom, 76% (n=581) underwent a TURB-alone and 24% (n=181) a TURB+TURP. There was no difference in terms of tumor characteristics between the groups. We observed comparable length of stay as well as complication rates including major complications (Clavien-Dindo grade ≥ 3) for the TURB alone versus TURB+TURP groups, while the latest led to longer operative time (p<0.001). During a median follow-up of 44 months, there were more recurrences in the TURB-alone (47%) compared to the TURB+TURP group (28%; p<0.001). Interestingly, there were more recurrences at the bladder neck/prostatic fossa in the TURB-alone group (55% vs. 3%; p<0.001). TURB+TURP procedures were associated with improved RFS (HR 0.39, 95% CI 0.29-0.53, p<0.001), but not PFS (HR 1.63, 95% CI 0.90-2.98, p=0.11). Within the PSM cohort of 254 patients, the simultaneous TURB+TURP was still associated with improved RFS (HR 0.33, 95% CI 0.22-0.49, p<0.001). This was also true in the subgroup of 380 patients with recurrence risk factors (HR 0.41, 95% CI 0.28-0.62, p<0.001).
In our contemporary cohort, simultaneous TURB and TURP seems to be oncologically safe option that may, even, improve RFS by potentially preventing disease recurrence at the bladder neck and in the prostatic fossa.
BJU international. 2022 Sep 22 [Epub ahead of print]
Ekaterina Laukhtina, Marco Moschini, Wojciech Krajewski, Jeremy Yuen-Chun Teoh, Guillaume Ploussard, Francesco Soria, Florian Roghmann, Mara Anna Muenker, Mathieu Roumiguie, Mario Alvarez-Maestro, Vincent Misrai, Alessandro Antonelli, Alessandro Tafuri, Giuseppe Simone, Riccardo Mastroianni, Hongda Zhao, Razvan-George Rahota, David D'Andrea, Keiichiro Mori, Simone Albisinni, Pierre I Karakiewicz, Harun Fajkovic, Dmitry Enikeev, Francesco Montorsi, Shahrokh F Shariat, Benjamin Pradere, European Association of Urology - Young Academic Urologists (EAU-YAU): Urothelial Carcinoma Working Group
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy., Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wroclaw, Poland., Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology, La Croix du Sud Hospital, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France., Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, Torino School of Medicine, Torino, Italy., Department of Urology, Marien Hospital Herne, Herne, Germany., Department of Urology, University Hospital of Toulouse Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France., Servicio de Urología, Hospital Universitario La Paz, Madrid, Spain., Department of Urology, Clinique Pasteur, Toulouse, France., Departement of Urology, University of Verona, Italy., IRCCS "Regina Elena" National Cancer Institute, Rome, Italy., Department of Urology, The Jikei University School of Medicine, Tokyo, Japan., Service d'Urologie, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada.