Transurethral bipolar plasma prostate resection or alpha 1A receptor blocker in combination with endocrine therapy for treatment of bladder outlet obstruction in patients with advanced prostate cancer

doi:10.3877/cma.j.issn.1674-0785.2018.03.004

Abstract

Abstract:

Objective

To investigate the clinical efficacy and safety of transurethral bipolar plasma prostate resection (TUPKP) combined with maximal androgen blockade (MAB ) and alpha 1A receptor blocker (α1A-b) combined with MAB in the treatment of bladder outlet obstruction (BOO) in patients with advanced prostate cancer.

Methods

From November 2010 to January 2017, 52 advanced prostate cancer patients with BOO at the Urological Department of Affiliated Hefei Hospital of Anhui Medical University were retrospectively analyzed, including 29 patients who underwent TUPKP plus MAB and 23 patients who underwent α1A-b treatment plus MAB. The t-test was used for comparison of prostate specific antigen (PSA), postvoid residual urine volume (PVR), quality of life score (QOL), the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and other variables between the two groups before and 3 months after treatment. The 1-, 3-, and 5-year survival rates and overall survival rate were compared between the two groups. Survival analysis was performed by Kaplan-Meier method, and log-rank test was used for comparison between the groups.

Results

Before treatment, the PSA, PVR, QOL, IPSS, and Qmax in the TUPKP+ MAB and 1A-b+ MAB groups were (37.94±25.58) μg/L vs (47.29±42.10) μg/L, (158.07±57.81) mL vs (151.17±55.70) mL, (5.10±0.82) vs (5.26±0.81), (26.62±3.78) vs (25.83±4.21), and (6.50±1.63) mL/s vs (6.60±2.26) mL/s, respectively. After 3 months of treatment, the PSA, PVR, QOL, IPSS, and Qmax in the two groups were (2.86±2.16) μg/L vs (5.19±3.54) μg/L, (31.17±19.97) mL vs (92.48±42.62) mL, (1.48±0.87) vs (4.00±1.04), (7.83±3.26) vs (16.57±3.87), and (18.27±4.47) mL/s vs (6.60±2.26) mL/s, respectively. After treatment, the PSA, PVR, QOL, and IPSS in the TUPKP+ MAB and 1A-b+ MAB groups decreased significantly compared with the values before treatment, while the Qmax significantly increased, and the difference was statistically significant (t=7.688, 14.013, 18.582, 22.737, -14.058, P<0.001; t=4.800, 9.716, 6.996, 8.377, -7.096, P<0.001, respectively). After 3 months of treatment, compared with the α1A-b+ MAB group, the PSA, PVR, QOL, and IPSS in the TUPKP+ MAB group significantly decreased (t=2.777, P=0.009; t=6.367, P<0.001; t=9.478, P<0.001; t=8.831, P=0.000), while the Qmax was higher, but the difference was not statistically significant (t=-1.762, P=0.084). There was no significant difference in the 1-, 3-, or 5-year survival rate or overall survival rate between the two groups (χ²=0.012, P=0.915).

Conclusions

Both TUPKP+ MAB and α1A-b+ MAB for advanced prostate cancer patients with BOO can significantly alleviate BOO symptoms and improve the quality of life. Compared with α1A-b+ MAB, TUPKP+ MAB has more significant effect and has no definite negative effect on the survival rate of the patients. TUPKP+ MAB is a safe and effective method for the treatment of BOO in patients with advanced prostate cancer.

Key words: Prostate cancer, Bladder outlet obstruction, Bipolar transurethral plasma kinetic prostatectomy, α1A-blocker, Endocrine therapy

Xiaoliang Yang, Yanbin Zhang, Can Wei, Wei Wang, Junhua Xi, Quansheng Ying, Wei Wu, Zhenxing Yang, Yun Chen, Dawei Ni. Transurethral bipolar plasma prostate resection or alpha 1A receptor blocker in combination with endocrine therapy for treatment of bladder outlet obstruction in patients with advanced prostate cancer[J]. Chinese Journal of Clinicians(Electronic Edition), 2018, 12(03): 142-147.

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References 17

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组别	例数	年龄（岁）	前列腺体积（ml）	骨转移［例（%）］	Gleason评分（分）	临床分期（例）
组别	例数	年龄（岁）	前列腺体积（ml）	骨转移［例（%）］	Gleason评分（分）	Ⅲ期	Ⅳ期
TUPKP＋MAB组	29	76.24±6.99	68.78±33.09	21（72.41）	6.79±0.98	5	21
α1A-b＋MAB组	23	74.22±5.33	63.22±27.97	16（69.57）	6.78±1.28	7	19
统计值	?	t=1.149	t=0.645	χ²=0.51	t=0.034	χ²=0.433
P值	?	0.256	0.522	0.822	0.973	0.510

组别	例数	年龄（岁）	前列腺体积（ml）	骨转移［例（%）］	Gleason评分（分）	临床分期（例）
组别	例数	年龄（岁）	前列腺体积（ml）	骨转移［例（%）］	Gleason评分（分）	Ⅲ期	Ⅳ期
TUPKP＋MAB组	29	76.24±6.99	68.78±33.09	21（72.41）	6.79±0.98	5	21
α1A-b＋MAB组	23	74.22±5.33	63.22±27.97	16（69.57）	6.78±1.28	7	19
统计值	?	t=1.149	t=0.645	χ²=0.51	t=0.034	χ²=0.433
P值	?	0.256	0.522	0.822	0.973	0.510

组别	例数	1年	3年	5年
TUPKP＋MAB组	29	89.65	72.41	62.07
α1A-b＋MAB组	23	91.30	69.57	60.87
χ²值	?	0.040	0.051	0.008
P值	?	0.841	0.822	0.930

组别	例数	1年	3年	5年
TUPKP＋MAB组	29	89.65	72.41	62.07
α1A-b＋MAB组	23	91.30	69.57	60.87
χ²值	?	0.040	0.051	0.008
P值	?	0.841	0.822	0.930

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