[Incidental carcinoma of the prostate: can we and should we recommend radical prostatectomy?]. / Inzidentelles Prostatakarzinom: Kann und soll die radikale Prostatektomie danach empfohlen werden?

INTRODUCTION: There is controversy regarding tumor control of incidental prostate cancer (PC). We evaluated in a large cohort if we can recommend radical prostatectomy after TURP. MATERIAL AND METHOD: In 52 (4.3%) from a total of 1207 patients undergoing radical prostatectomy the diagnosis had been made by TURP. In a retrospective analysis we evaluated morbidity, histopathological results, and tumor control of pT1a/b tumors. RESULTS: The number of incidentally detected PC decreased with time. In 5.8% in the TURP group and in 0.5% of the needle biopsy group, there was no residual tumor found (p<0.001). Morbidity was similar +/- TURP with the exception of operation time (206 vs 188 min) and catheter duration (19.3 vs 17.3 days). Postoperative continence was identical. There was no difference in tumor control for local recurrence-free survival and PSA-free survival with and without TURP. CONCLUSIONS: The rate of incidentally detected PC by TURP decreases over time, but in almost all cases we found clinically relevant cancer. TURP is not an adverse prognostic factor and morbidity is similar compared with patients who were diagnosed by needle biopsy. Our data confirm that we should recommend radical prostatectomy to patients who are candidates for further curative therapy.

[Transurethral resection for benign prostatic hyperplasia. current developments]. / Transurethrale Resektion bei benigner Prostatahyperplasie. Aktuelle Entwicklungen.

Transurethral resection of the prostate still represents the "gold standard" in surgical treatment of symptomatic benign prostatic enlargement (BPE). New demands were made on transurethral electrosurgery with the appearance of alternative, minimal invasive procedures. Bleeding complications had to be reduced. Different attempts were made to improve the conventional TURP. Band loops and roller bars were developed in order to gain a more effective coagulation during the cutting process by a larger tissue contact. Major advances could be achieved by modifications of the high-frequency generator. Improved procedures like the "Coagulating-Intermittent-Cutting" (CIC), the "Instant-Response-", as well as the "Dry-Cut-Technology" combine cutting and coagulating effects to realize lowered bleeding and an efficient resection process. The introduction of bipolar currency flow opens the possibility of conventional TUR-P with saline solutions and thus to the theoretical avoidance of the TUR-syndrome. By the neoadjuvant use of 5alpha-reductase-inhibitors before planned TUR-P, bleeding- and irrigation fluid absorption should be reduced by lowering perfusion and the size of the prostate. Regarding these innovative approaches which improve the surgical standard and minimize the risk of perioperative complications, transurethral electrosurgery remains the method of choice in instrumental therapy of symptomatic BPE. In the future efficacy and costs will be comparable to those of the transurethral laser-resection or laser-vaporisation.

[Significance of neoadjuvant therapy before radical prostatectomy]. / Stellenwert der neoadjuvanten Therapie vor radikaler Prostatektomie.

Neoadjuvant therapy before radical prostatectomy should increase survival in patients. This is necessary especially in patients with adverse prognostic factors for locally advanced disease, because in this stage radical prostatectomy as the only treatment results in a significantly reduced rate of progression-free survival. The aim of neoadjuvant therapy protocols is to increase local tumor control because of possible downstaging effects of the tumor and to improve systemic control because of elimination of circulating tumor cells and possible micrometastases. This review discusses the present and future aspects of neoadjuvant therapies in detail. The neoadjuvant hormonal therapy prior to radical prostatectomy results in a significant downstaging that does not translate into prolonged disease-free survival. This observation was made for short-term (3 months) and long-term (8 months) hormonal therapy. Therefore, neoadjuvant hormonal therapy has only a cosmetic effect on the pathological results and should not be advocated any more. Newer protocols have shown that neoadjuvant chemotherapy or hormone chemotherapy is feasible. The results obtained in non-randomized trials with small numbers of patients do not allow analyzing the efficacy of these protocols. Theoretically, neoadjuvant chemotherapy, especially a taxane-based protocol, which has shown efficacy in hormone-refractory disease, could improve disease outcome. Clinical trials are underway to prove this hypothesis. In the future, new therapeutic strategies could also be used in the neoadjuvant setting. It can only be speculated if antibody protocols or gene therapy will be used in this respect. In conclusion, there is no standard neoadjuvant protocol prior to radical prostatectomy. Whether chemotherapy will set a new standard for care has to be elucidated by the ongoing clinical trials.