SURVIVAL AFTER TRANSURETHRAL AND TRANSVESICAL SURGERY IN LOCALIZED CANCER OF THE PROSTATE, NORWAY 1957-1981

Background. During the period 1957-1981, there has been a gradual change in the choice of surgical methods for patients with prostate cancer in Norway, from transvesical surgery to transurethral resections (TUR-P). Radical prostatectomy was practically nonexistent in the early years of this time period. Sixty-five percent (17,696 patients) of all patients with prostate cancer reported to the Cancer Registry had no metastases at the time of diagnosis. Of these, 5414 patients underwent TUR-P, whereas 6160 patients underwent transvesical operations as primary surgery. Interest was raised in analyzing survival after primary surgery. Methods and Results. Five-year relative survival rates were calculated for the groups of patients undergoing each type of surgery; the rates increased steadily for both groups during the later years of the 1957-1981 period. However, survival consistently was better for patients who had transvesical surgery. The difference in 5-year relative survival rates was 10-15%. The same pattern was seen long-term survival (more than 10 years). In addition, survival rates for patients with similar grade of tumor differentiation were better for patients undergoing transvesical surgery. A multivariate analysis of survival that related age, surgical methods, grades of tumor differentiation, and diagnostic periods showed that survival was influenced most by differentiation, followed by surgery. Age was not an important factor in this analysis. Conclusions. The results underline the importance of additional research regarding the precise classification of prostatic cancer at the time of diagnosis so that clinicians can better choose the proper method of surgery.