The practice of palliative TURP for advanced prostate cancer: our experience in northern Tanzania

Abstract

Background: Palliative transurethral resection of the prostate (TURP) is one of the palliative treatments for advanced prostate cancer (PCa). Most PCa patients in sub-Saharan Africa present late, with many patients presenting to our centre requiring palliative TURP to relieve bladder outlet obstruction (BOO). An extensive literature search showed limited work on palliative TURP in sub-Saharan Africa. Therefore, we chose to present our experience of palliative TURP at the Urology Institute of Kilimanjaro Christian Medical Centre (KCMC) in northern Tanzania. The findings of this study will help to guide our future practice, provide facts for counselling patients, and enhance future studies.

Methods: This is a retrospective study of our patients who underwent palliative TURP from 1 January 2013 to 31 December 2017. Relevant data was retrieved from hospital records and via phone calls. Descriptive and analytical analyses were done and results were presented using tables, figures, and prose.

Results: Only 22 patients met our strict inclusion criteria. The mean age of the patients was 73 ± 10 years. The 16 (72.75%) patients who had palliative TURP were using urethral catheters, while 27.3% were not but had significant post void residual (PVR) urine volume of 135 ± 119 ml. Two patients also had associated haematuria. The mean preoperative prostate-specific antigen (PSA) level was 122.4 ± 158 ng/mL. The mean resected weight was 13.4 ± 8.5 g. All the patients had a successful trial without catheter (TWOC) at 2.2 ± 0.6 days post-palliative TURP. Of the patients, 50% were on either surgical or medical androgen deprivation therapy (ADT), while the rest were not. At a mean follow-up of 34.9 ± 15.1 months post-palliative TURP, 13 (59.1%) patients were alive. All the surviving patients were passing urine unaided, except one who was using a suprapubic catheter (SPC).

Conclusion: Palliative TURP is effective in managing BOO in advanced PCa patients in our centre. However, a prospective study is suggested to unravel the factors responsible for the low survival rate recorded in this index study.