Research Article: Management of Localized Prostate Cancer by Focal Transurethral Resection of Prostate Cancer: An Application of Radical TUR-PCa to Focal Therapy

Date Published: May 22, 2012

Publisher: Hindawi Publishing Corporation

Author(s): Masaru Morita, Takeshi Matsuura.


Background. We analyzed radical TUR-PCa against localized prostate cancer. Patients and Methods. Seventy-nine out of 209 patients with prostate cancer in one lobe were studied. Patients’ age ranged from 58 to 91 years and preoperative PSA, 0.70 to 17.30 ng/mL. In other 16 additional patients we performed focal TUR-PCa. Patients’ age ranged from 51 to 87 years and preoperative PSA, 1.51 to 25.74 ng/mL. Results. PSA failure in radical TUR-PCa was 5.1% during the mean follow-up period of 58.9 months. The actuarial biochemical non-recurrence rate was 98.2% for pT2a and 90.5% for pT2b. Bladder neck contracture occurred in 28 patients (35.4%). In 209 patients, pathological study revealed prostate cancer of the peripheral zone near the neurovascular bundle bilaterally in 25%, unilaterally in 39% and no cancer bilaterally in 35%, suggesting the possibility of focal TUR-PCa. Postoperative PSA of 16 patients treated by focal TUR-PCa was stable between 0.007 and 0.406 ng/mL at 24.2 months’ follow-up. No patients suffered from urinary incontinence. Bladder neck contracture developed in only 1 patient and all 5 patients underwent nerve-preserving TUR-PCa did not show erectile dysfunction. Conclusion. Focal TUR-PCa was considered to be a promising option among focal therapies against localized prostate cancer.

Partial Text

Current standard radical surgery [1–3] against localized prostate cancer (PCa) has possible risks to disturb urinary continence or erectile function because they target the whole prostate. Many operative procedures [4–6] were introduced to improve the recovery of postoperative sexual function and urinary incontinence, such as bladder neck suspension or reconstruction, reconstruction of the rhabdosphincter, periurethral suspension of the dorsal vein complex/urethral complex and preservation of the neurovascular bundle to preserve erectile function [7]. But all these have failed to solve the problems completely until now. Irradiation therapy such as brachytherapy [8], three-dimensional conformal radiation therapy (3D-CRT) [9], or intensity-modulated radiation therapy (IMRT) [10] cannot completely prevent urinary incontinence, intestinal damage, or erectile dysfunction as well.

We could get a satisfactory cancer control with less invasive procedure of RTUR-PCa and FTUR-PCa. Although the results of long-term followup with more cases need to be studied, the procedure we report here could be a potential option of focal therapy against localized prostate cancer with minimum adverse effect on urinary continence and erectile function.