Will having a Transurethral Resection of the Prostate (TURP) spread prostate cancer?

TURP Does Not Spread Prostate Cancer

TURP can be safely performed in patients with prostate cancer without increasing the risk of tumor dissemination or compromising subsequent radical treatment. The theoretical concern about spreading cancer cells during resection has been thoroughly investigated and found to be negligible in clinical practice.

Evidence Against Cancer Spread

The most comprehensive review of this question found that the risk of tumor dissemination during TURP is small or negligible 1. When pathological stage is controlled for, progression and mortality outcomes are similar between patients who underwent TURP and those who did not 1.

Key Clinical Findings:

• No increased mortality: Studies of patients undergoing TURP for prostate cancer show no perioperative deaths and acceptable outcomes 2
• Stage-matched outcomes: When comparing patients with known pathological stage, TURP does not worsen cancer progression or survival rates 1
• Effective symptom relief: 72.5% of patients with prostate cancer achieve normal voiding after TURP, with relatively low morbidity 3

Important Clinical Context

Patients with prostate cancer who develop obstructive symptoms tend to have higher-stage disease at presentation 1. This creates a selection bias—it's not the TURP causing worse outcomes, but rather that patients requiring TURP already have more advanced disease.

Detection vs. Dissemination:

• TURP can detect transition zone prostate cancers missed by transrectal biopsy, with detection rates of 7.9% overall 4
• Detection rates increase to 16.5% in patients with abnormal digital rectal examination 4
• This represents cancer detection, not cancer spread 5, 4

Timing Considerations for Subsequent Treatment

If TURP is performed before definitive cancer treatment, specific timing protocols minimize complications:

• Delay radiation therapy 6-8 weeks after TURP to minimize incontinence and bladder neck contracture to acceptable levels 1
• Radical prostatectomy can be performed with no increased morbidity following TURP 1

Morbidity Profile

The main complications of TURP in cancer patients relate to the procedure itself, not cancer spread:

• Incontinence risk is higher than in benign disease but remains acceptable for most patients 2
• Incontinence occurs primarily when resection extends through the external sphincter invaded by tumor 2
• Overall complication rate of 27.5%, including persistent obstruction and incontinence 3

Clinical Algorithm

For patients with prostate cancer and obstructive symptoms:

1. TURP is appropriate for symptom relief without concern for spreading cancer 2, 1
2. If definitive treatment is planned:
   • Wait 6-8 weeks before radiation therapy 1
   • Radical prostatectomy can proceed without delay 1
3. Avoid extending resection through tumor-invaded sphincter to minimize incontinence 2

The historical concern about TURP spreading prostate cancer is not supported by clinical evidence and should not prevent appropriate surgical management of obstructive symptoms 1.