TRANSURETHRAL RESECTION FOR PROSTATIC CANCER

Abstract

Prostatic cancer now is a problem of increasing importance in Japan. Various types of treatment for prostatic cancer have been tried and evaluated so far, yet hundreds of patients die every year because of difficulty in its early diagnosis. Although most urologists have the opinion that radical prostatectomy may be the only cure for prostatic cancer, it is also a fact that complications noted in the radical prostatectomy sometimes give more trouble to the patient than the disease itself. Transurethral resection of course is not a radical measure, but a conservative one to relieve obstruction of the lower urinary tract caused by the condition. This paper is given to report our late experiences of thirty-four transurethral resections which were performed in twenty-eight patients of prostatic cancer at the Jikei University Hospital and the Iwate Medical University Hospital, from Februafy 1961 to January 1965.
Of the total twenty-eight patients, twenty-one patients (75per cent) were diagnosed as incurable cancer upon initioal examination, classified as group C or D by Kaufman's classification. The remaining seven patients (25per cent) were classified as group A or B. These cases could be called as curable cancer by radical prostatic surgery, but transurethral resection was chosen because of patient's senility or poor general condition. Obstructive urinary symptoms were the chief complaints in the majority of the patients (25 patients: 89per cent).
The amount of tissue resected weighed 10 grams on the average, oaring from 1 to 42 grams, and the time needed for the resecting procedure was 42 minutes on the average, oaring from 5 to 65 minutes. Satisfactory relief of the obstructive urinary symptoms was obtained in all the cases.
Urigal (cytal) was used as an irrigating medium in all the cases, and no remarkable change was noted in the postoperative serum electrolytes.
The blood loss during the resecting procedure was about 134cc, macroscopic hematuria disappeared within two to three days and indwelling catheter was removed on the 3rd postoperative day on the average.
Endocrine therapy, either by the administration of antiandrogenic hormone or by intracapsular orchiectomy or by a combination of the two has been done in all the patients.
Of the total twenty-eight patients, seventeen patients (61per cent) have been known to be alive and continued to be under our observation. Nine patients (32per cent) had died either by the disease (7 patients) or by postoperative complications (2 patients). No communication was obtained postoperatively from the remaining two cases.
Of the seventeen patients, in each of whom combined therapy of transurethral resection and anti-androgenic hormone was performed, nine patients were noted to have been surviving up to Jauary 1965, that it for more than 14 months (5 to 42 months) postoperatively on the average. Of the nine patients, in whom intracapsular orchiectomy was performed along with transurethral resection and also administration of antiandrogenic hormone, eight patients were noted to have been surviving for more than 24 months (5 to 45 months) after the operation on the average.
Fourteen patients who were classified as group A, B or C upon initial examination revealed apparently better survival rate (86per cent) than the twelve patients classified as group D (42per cent).
Taking the above mentioned results into consideration, the authors assumed that transurethral resection is a desirable operation for relief of obstructive urinary symptoms noted in prostatic cancer.
Combined therapy of administration of antiandrogenic hormone together with intracapsular orchiectomy is recommended.