Optimal Timing of Radical Prostatectomy for Incidental Prostate Cancer Following TURP: A Systematic Review
DOI:
https://doi.org/10.33192/smj.v78i11.281569Keywords:
prostatectomy, prostatic neoplasm, transurethral resection of prostate, time-to-treatment, active surveillanceAbstract
Objective: To evaluate existing evidence on the optimal timing of radical prostatectomy (RP) following transurethral resection of the prostate (TURP) in patients with incidental prostate cancer (iPCa), with consideration of surgical feasibility as well as oncological and functional outcomes.
Materials and Methods: Following PRISMA 2020, PubMed, the Cochrane Library and EBSCO were searched, with ScienceDirect as a supplementary source, for English-language studies published between 2015 and 2025 that reported the interval between TURP and RP. Risk of bias was assessed with the Newcastle–Ottawa Scale, and findings were combined by structured narrative synthesis.
Results: Ten reports from nine observational cohorts (at least 612 eligible patients confirm) were included; none was randomized. Only two studies compared intervals directly, using different thresholds (≤12 vs. >12 weeks, n = 56; <12 vs. ≥12 months, n = 144); neither found significant differences in the outcomes assessed (complications, margins, continence, PSA recurrence or quality of life). Four single-interval series found RP after TURP feasible but technically more demanding. Three active surveillance cohorts, analyzed as contextual evidence, observed few or no cancer-specific deaths.
Conclusion: Limited, heterogeneous and predominantly retrospective evidence did not show a clear association between the TURP-to-RP interval and surgical, oncological or functional outcomes, but it cannot exclude an effect of timing or define an optimal interval. Management should be individualized according to stage, grade group, PSA, residual disease and life expectancy.
References
1. Guo Z, He J, Huang L, Wang Z, Hu P, Wang S. Prevalence and risk factors of incidental prostate cancer in certain surgeries for benign prostatic hyperplasia: A systematic review and meta-analysis. Int Braz J Urol. 2022;48:915–29.
2. Capogrosso P, Capitanio U, Vertosick E, Ventimiglia E, Chierigo F, Oreggia D. Temporal trend in incidental prostate cancer detection at surgery for benign prostatic hyperplasia. Urology. 2018;122:152–7.
3. Hagmann S, Ramakrishnan V, Tamalunas A, Hofmann M, Vandenhirtz M, Vollmer S. Two decades of active surveillance for prostate cancer in a single-center cohort: Favorable outcomes after transurethral resection of the prostate. Cancers. 2022;14(2):368.
4. Tsaur I, van den Bergh R, Soeterik T, Thomas A, Brandt M, Zattoni F. Predictors of unfavorable pathology in patients with incidental (pT1a-T1b) prostate cancer. Eur Urol Focus. 2022;8(6):1599–606.
5. Liao H, Duan X, Du Y, Mou X, Hu T, Cai T. Radical prostatectomy after previous transurethral resection of the prostate: oncological, surgical and functional outcomes-a meta-analysis. World J Urol. 2020;38(8):1919–32.
6. Srinualnad S, Udompunturak S. Is radical prostatectomy after transurethral resection of prostate (TUR-P) feasible? Siriraj Med J. 2005;57(10):440–2.
7. Abedi A, Ghiasy S, Fallah-Karkan M, Rahavian A, Allameh F. The management of patients diagnosed with incidental prostate cancer: narrative review. Res Rep Urol. 2020;12:105–9.
8. Cheng B, Castellani D, Chan I, Baker A, Gauhar V, Wroclawski M. Incidence, predictive factors and oncological outcomes of incidental prostate cancer after endoscopic enucleation of the prostate: a systematic review and meta-analysis. World J Urol. 2022;40(1):87–101.
9. Li H, Zhao C, Liu P, Hu J, Yi Z, Chen J. Radical prostatectomy after previous transurethral resection of the prostate: a systematic review and meta-analysis. Transl Androl Urol. 2019;8(6):712.
10. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
11. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [Internet]. Ottawa: Ottawa Hospital Research Institute; [cited August 11th 2025]. Available from: https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
12. Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ. 2020;368:l6890.
13. Herden J, Schwarte A, Boedefeld E, Weissbach L. Active surveillance for incidental (cT1a/b) prostate cancer: Long-term outcomes of the prospective noninterventional HAROW study. Urol Int. 2021;105(5–6):428–35.
14. Herden J, Schwarte A, Werner T, Behrendt U, Heidenreich A, Weissbach L. Long-term outcomes of active surveillance for clinically localized prostate cancer in a community-based setting: results from a prospective non-interventional study. World J Urol. 2021;39(7):2515–23.
15. Ahn H, Lee K, Koo K, Chung B. Clinical experience with active surveillance protocol using regular magnetic resonance imaging instead of regular repeat biopsy for monitoring: A study at a high-volume center in Korea. Prostate Int. 2021;9(2):90–5.
16. Wang Y, Zheng X, Mao Q, Xie L. Interval from transurethral resection of prostate to laparoscopic radical prostatectomy does not affect outcomes for incidental prostate cancer. Arch Med Sci. 2024;20(1):133–7.
17. Pastore A, Palleschi G, Silvestri L, Leto A, Al-Rawashdah S, Petrozza V. Laparoscopic radical prostatectomy after previous transurethral resection of prostate using a catheter balloon inflated in prostatic urethra: Oncological and functional outcomes from a matched pair analysis. Int J Urol. 2015;22(11):1037–42.
18. Chaloupka M, Figura F, Weinhold P, Jokisch F, Westhofen T, Pfitzinger P. Impact of previous transurethral prostate surgery on health-related quality of life after radical prostatectomy: Does the interval between surgeries matter? World J Urol. 2021;39(7):2819.
19. Yang Y, Luo Y, Hou G, Huang Q, Lu M, Si-tu J. Laparoscopic radical prostatectomy after previous transurethral resection of the prostate in clinical T1a and T1b prostate cancer: A matched-pair analysis. Urol J. 2015;12(3):2154–9.
20. Tugcu V, Atar A, Sahin S, Kargi T, Seker K, Comez Y. Robot-assisted radical prostatectomy after previous prostate surgery. JSLS. 2015;19(4):e2015.00080.
21. EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer. Edn. presented at the EAU Annual Congress Madrid 2025. Arnhem: EAU Guidelines Office; 2025 [cited August 11th 2025]. Available from: https://uroweb.org/guidelines/prostate-cancer
22. Jones J, Follis H, Johnson J. Probability of finding T1a and T1b (incidental) prostate cancer during TURP has decreased in the PSA era. Prostate Cancer Prostatic Dis. 2009;12(1):57–60.
23. Choomark S, Aussavavirojekul P, Woranisarakul V, Srinualnad S. Cancer Detection Rate of MRI Ultrasound Fusion Prostate Biopsy in 1,039 Patients and Number Needed to Biopsy in Targeted Lesion. Siriraj Med J. 2023;75(11):770–7.
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