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Does prostate removal decrease life expectancy?

After 23 years the men treated with radical prostatectomy gained a mean of 2.9 extra years of life. The researchers found that the absolute benefit associated with radical prostatectomy increased by a factor of more than two from 10 to 23 years' follow-up in terms of overall mortality and disease specific mortality.

bmj.com - Radical prostatectomy extends life expectancy in localised prostate ...

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Does prostate removal reduce life expectancy?

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Susan Mayor London

Radical prostatectomy is associated with significantly more years of life gained than watchful waiting in men with localised prostate cancer, long term follow-up results from a randomised trial have shown.1 “In clinically detected prostate cancer, the benefit of radical prostatectomy in otherwise healthy men can be substantial, with a mean gain of almost three years of life after 23 years of follow-up,” said the study authors, led by Anna Bill-Axelson, from Uppsala University Hospital in Sweden. But they warned that the benefit is highly dependent on a man’s baseline risk, which can now be better assessed with modern diagnostic procedures than in the past. Radical prostatectomy is known to reduce mortality in men with clinically detected localised prostate cancer, but evidence from randomised trials with long term follow-up has been limited. The Scandinavian Prostate Cancer Group Study Number 4 randomly assigned 695 men with localised prostate cancer that was clinically detected from October 1989 to February 1999 to undergo radical prostatectomy or watchful waiting. The patients had to be under 75 or to have a life expectancy of over 10 years at the start of the trial. They were followed up every six months for the first two years and then yearly. The results, published in the New England Journal of Medicine,1 showed significantly fewer deaths from prostate cancer in men who underwent radical prostatectomy (71 deaths) than in the watchful waiting group (110 deaths) during follow-up to 31 December 2017. This meant that the relative risk of death from prostate cancer was 45% lower with radical prostatectomy (relative risk 0.55 (95% confidence interval 0.41 to 0.74); P<0.001), while the absolute reduction in risk was 11.7% (5.2% to 18.2%). The number needed to treat to avert one death from any cause was 8.4. After 23 years the men treated with radical prostatectomy gained a mean of 2.9 extra years of life. The researchers found that the absolute benefit associated with radical prostatectomy increased by a factor of more than two from 10 to 23 years’ follow-up in terms of overall mortality and disease specific mortality. The research group cautioned, “The length of time for a more substantial benefit to occur even among men with more advanced tumours, as in our trial, highlights the importance of carefully selecting men who might benefit from curative treatment and not treating the small, low risk tumours often diagnosed today, unless they show signs of progression during active surveillance.” They added that the long latency period underlined the need to consider a patient’s expected remaining lifetime when recommending treatment options. One limitation of the trial, which was funded by the Swedish Cancer Society and other non-profit research organisations, is that diagnostic procedures for prostate cancer have changed dramatically. Most men who have prostate cancer diagnosed now undergo multiple biopsies or imaging with targeted biopsies, which has improved the detection of high grade cancers as part of informing treatment decisions. The study authors concluded, “The remaining expected lifetime is important in decision making, with the reservation that it is hard to predict.” For applying the trial findings to current practice they recommended that clinicians consider the lead time gained by screening, as well as overdiagnosis of non-lethal cancers and the ability of modern diagnostics to better define risk groups.

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What is the success rate of TURP surgery?

What is the success rate of TURP surgery? The 5-year risk rate for a reoperation following TURP is approximately 5%. Overall mortality rates following TURP by a skilled surgeon are virtually 0%.

urology-sd.com - TURP - Urology San Diego

Transurethral resection of the prostate (TURP) is a surgery used to treat urinary problems that are caused by an enlarged prostate. An instrument called a resectoscope is inserted through the tip of your penis and into the tube that carries urine from your bladder (urethra). The resectoscope helps your doctor see and trim away excess prostate tissue that’s blocking urine flow. TURP is generally considered an option for men who have moderate to severe urinary problems that haven’t responded to medication. While TURP has been considered the most effective treatment for an enlarged prostate, a number of other, minimally invasive procedures are becoming more effective. These procedures generally cause fewer complications and have a quicker recovery period than TURP.

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