BERKELEY, CA (UroToday.com) - In our recent paper, we studied the validity of focal transurethral resection of prostate cancer (TUR-PCa) based on our 209 cases of radical TUR-PCa, and we proposed focal TUR-PCa as an option for focal therapy against prostate cancer. We reported the clinical results of 16 initial cases.
We proposed two types of focal TUR-PCa. Both procedures require confirmation of cancer localization obtained from ultrasound-guided transrectal biopsy. In one procedure, we radically resect the affected one lobe with the unaffected lobe being resected, as in advanced transurethral resection of the prostate (TURP) for benign prostate hyperplasia (BPH) (one lobe radical TUR); and in the other procedure we radically resect both lobes, except for the prostate tissues near the neurovascular bundle (nerve sparing radical TUR). In the latter procedure, we understandably perform advanced TUR-PCa between the 4 and 8 o’clock position to examine for the extent of cancer. In addition, we have recently started another variant of TUR-PCa, target TUR-PCa, in patients with a probable small volume of cancer in one localized area of the prostate, judging from the result of biopsy. Radical TUR-PCa may be technically a slightly more difficult procedure because it requires successful handling of the venous sinus that is opened during the deep resection of the peripheral zone. However, it is a procedure with a high degree of freedom because we can determine the extent of resection depending on the localization of cancer. Postoperative bladder neck contracture develops 3 to 4 months after radical TUR-PCa in 30 to 40% of patients because of aggressive bladder neck resection to achieve radicality. It can, however, be treated easily by transurethral cold incision. Development of bladder neck contracture is the most troublesome problem that now confronts us, but we may be able to reduce the occurrence rate by focal TUR-PCa.
Concerning the method of current focal therapy – such as cryotherapy or HIFU – the most important point seems to be the selection of suitable patients. To achieve this, much effort has been made to improve the accuracy to determine the localization, extension, and malignant grade of cancer with tools such as saturation biopsy or MRI. Our procedure of focal TUR-PCa appears to have an advantage in this case because we can obtain adequate pathologic samples. More accurate distribution of cancer in the prostate can be examined and diagnosed by advanced TURP, which can supplement the limitation of common biopsy.
The last point that we would like to state, with special emphasis, is that our operative procedure may give an answer to the criticism that PSA screening may lead to over diagnosis, resulting in overtreatment. We can easily eradicate the early diagnosed, small-volume cancer focus of our procedure with the benefit of continence and erectile function being preserved. We may insist that for the treatment of prostate cancer, early diagnosis and early treatment be the basic policy as it is in the treatment of other cancers.
Our procedure can be performed at any urological institute. It is a less invasive and low-cost method of treatment for prostate cancer, though a little more experience is necessary than in the execution of TURP for BPH.
Written by:
Masaru Morita, MD, PhD1 and Takeshi Matsuura, MD, PhD2 as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
1 1917-3 Asakura-Hei, Kochi, Kochi 780-8063, Japan
E-mail:
2 Department of Urology, Matsubara Tokushukai Hospital, Osaka, Japan
More Information about Beyond the Abstract