Thirty-day mortality after transurethral resection of the prostate in patients treated with androgen deprivation therapy.
OBJECTIVE
Seven percent of patients with prostate cancer (PCa) who are exposed to androgen deprivation therapy (ADT) may need transurethral resection of the prostate (TURP). Our objective was to examine the rate and the predictors of 30-day mortality (30dM) after TURP in patients who were exposed to ADT in a large, contemporary Canadian cohort.


METHODS
We assessed the 30dM rate after TURP in 853 men with the diagnosis of PCa who were treated with primary ADT or radiation therapy followed by ADT. The effect of age, comorbidity (coded according to the Charlson Comorbidity Index [CCI]), number of previous TURP procedures, history of radiation therapy, exposure to antiandrogens, and the type and the duration of ADT before TURP were all tested in univariable and multivariable logistic regression models that predicted 30dM after TURP.


RESULTS
During the initial 30 days after TURP, 38 deaths occurred (4.5%, 95% confidence interval: 3.2%-6.2%). Of all variables, the CCI was the only statistically significant (P = 0.001) predictor of 30dM after TURP. The accuracy of CCI in predicting 30dM after TURP in individual patients was 65.1%. Lack of consideration of clinical variables that could predict the 30dM rate after TURP, such as prostate size or prostate-specific antigen level, represents a limitation of this study.


CONCLUSIONS
A substantial risk of 30dM is associated with TURP that is performed in patients who are exposed to ADT. Unfortunately, the predictors used in this analysis could not define the individual risk of 30dM with sufficient accuracy. Nonetheless, the average 4.5% risk should be considered at the time of informed consent.
Isbarn
Hendrik
H
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
Jeldres
Claudio
C
Capitanio
Umberto
U
Zini
Laurent
L
Shariat
Shahrokh F
SF
Lughezzani
Giovanni
G
Sun
Maxine
M
Ahyai
Sascha A
SA
Duclos
Alain
A
Jolivet-Tremblay
Martine
M
Lattouf
Jean-Baptiste
JB
Valiquette
Luc
L
Perrotte
Paul
P
Montorsi
Francesco
F
Graefen
Markus
M
Karakiewicz
Pierre I
PI
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000728:Androgens / Q000172:deficiency*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000628:therapy*; D011792:Quebec; D012044:Regression Analysis; D020728:Transurethral Resection of Prostate
D000728:Androgens