Operative course of transurethral resection of the prostate and progression of prostate cancer.

Surgery has the potential to disseminate cancer cells, and we therefore hypothesized that extensive transurethral resections of the prostate (TURP) would be followed by a worse prognosis than minor ones. For this purpose, the association between the extent of surgery, disease progression, and mortality was studied in 138 patients with prostatic cancer who had undergone TURP. The results show that a large bleed (> or = 275 ml) indicated a slightly increased relative risk of general progression of the cancer (relative risk (RR) = 1.9, 95% confidence interval (CI) = 0.9-4.1) and death (RR = 1.5, CI = 0.6-3.3). Other parameters of extensive surgery, such as the operating time and fluid absorption, were not associated with increased risk. Patients with a medical disease, however, such as hypertension and congestive heart failure, had a significantly higher relative risk of general progression (RR = 2.7, CI = 1.2-6.1) and death from prostatic cancer (RR = 4.6, CI = 2.0-10.7) in addition to an increased relative risk of death from other causes (RR = 3.7, CI = 1.3-10.5). We conclude that concurrent medical disease, but not an extensive TURP, worsened the prognosis of patients with prostatic cancer who underwent TURP.