BPH 01. Concurrent surgeries for benign prostatic hyperplasia and prostate cancer: Analysis of 16 cases

Objective: To explore the safety of the concurrent transurethral resection of the prostate (TURP) and transurethral resection of bladder tumor (TURBT).

Methods: A total of 16 patients age 52-80 years (mean: 62 years) with benign prostatic hyperplasia (BPH) and prostate cancer were treated in our hospital from January 2001 to January 2011. All these 16 patients had hematuria, accompanied with various lower urinary tract symptoms (LUTS). Four patients had acute urinary retention and 11 experienced dysuria. All patients underwent ultrasound, cystoscopy, and CT. These tumors were solitary in 12 patients and multiple in 4 patients. The prostate showed moderate hyperplasia in 11 patients and severe hyperplasia in 5 patients. TURP and TURBT were performed in 12 cases, and concurrent TURP and TURBT was performed in 4 cases.

Results: All these 16 patients were followed up. The follow-up ranged 6 months (n=1), 12 months (n=3), 24 months (n=10), and 30-60 months (n=2). Three patients experienced recurrence 6 months, 28 months, and 36 months after surgery, respectively. The sites of recurrence were not in situ or prostate fossa. LUTS and dysuria were cured or improved after surgery.

Discussion: Clinically, BPH combined with prostate cancer is not a rare condition due to their same ages of high prevalence. Furthermore, some reports have indicated that BPH may trigger the development of prostate cancer. Diagnosis of BPH should also pay attention to the potential existence of prostate cancer. Whether the concurrent surgeries for both BPH and prostate cancer may cause neoplasm seeding and thus increase the risk of tumor relapse is still controversial. For elderly patients with mild BPH, treatment may be focused on prostate cancer only. For moderate and severe BPH, concurrent surgeries may be beneficial and appropriate. When the surgeries were performed concurrently, the prostate cancer is resected firstly. When TURBT is performed, the tumors are washed out using Ellic flusher and then TURP is performed, so as to ensure the procedures are performed under a "tumor-free" environment. Meanwhile, the clear operational field is also helpful to remove the tumors. However, since the concurrent surgeries require continuous prostate brushing, and therefore chemotherapy drugs can not be administered in the urinary bladder early. In fact, after the brushing stops, chemotherapy drugs should be administered early to prevent neoplasm seeding.