Mortality and prostate cancer risk in 19 598 men after surgery for benign prostatic hyperplasia

Objectives. To examine postoperative mortality and prostate cancer risk after the first prostatectomy for benign prostatic hypertrophy over a 17-year period in a population-based cohort of men in Western Australia, using improved methods to adjust for comorbidity. Patients and methods. The relative survival from death and prostate cancer incidence was calculated against the background population rates. The outcomes of transurethral resection of the prostate (TURP) and open prostatectomy (OP) were compared adjusting for calendar year, age, admission type and comorbidity using Cox regression. Fractional polynomials were used to take account of nonlinearity in confounder effects. Results. At 10 years, the relative survival was 116.5% in TURF patients and 123.5% after OP. Adjusting only for confounding by age, calendar year and admission type, TURF had a higher mortality rate than OP (rate ratio, RR, 1.20; 95% confidence interval 1.08-1.34), The RR fell to 1.10 (0.99-1.23) after adjustment for comorbidity and to 1.07 (0.95-1.19) when accounting for nonlinearity. The relative survival from the incidence of prostate cancer at 10 years was 103.7% after TURF and 104.5% after OP. The RR adjusted for age and calendar year was 1.44 (0.94-2.21) for incidence and 1.37 (0.81-2.29) for prostate cancer mortality. Conclusion. There is at most a small and clinically unimportant excess mortality risk from TURF; any difference could be due to a protective effect of OP on the long-term risk of prostate cancer and a lower rate of repeat prostatectomy.