Prostate cancer post-TURP should be treated as high-risk disease

Researchers at Fox Chase Cancer Center in Philadelphia recommend more aggressive treatment in men whose prostate cancers occurred after transurethral resection of the prostate and whose PSA level is considered intermediate. They presented a study supporting this recommendation at the American Society for Therapeutic Radiology and Oncology annual meeting in Denver.

The study evaluated 1,287 men with low to intermediate risk with a similar stage of disease. All had pretreatment PSA levels <20.0 ng/mL and received 3-D conformal radiotherapy without hormone therapy. Of these, 143 men had a prior TURP. Median pretreatment PSA was 7.3 ng/mL, and 362 men (28%) had a PSA >10 ng/mL.

Prior TURP was the common denominator among patients who had a pretreatment PSA of 10 to 19.9 ng/mL who later recurred. These patients also had other pretreatment indicators, including a Gleason score of 2 to 6 versus 7, and stage T1c versus T2, that normally would not have indicated a high risk of recurrence, the authors noted. No strong relationship was observed between surgery and recurrence for those with a pretreatment PSA <10 ng/mL.

“A history of TURP reduced the accuracy of PSA as a pretreatment indicator for recurrence,” said lead author David J. D’Ambrosio, MD. “The treatment plan for men who have an intermediate PSA who have also had TURP may include a recommendation of androgen deprivation.”