Senior Urologist & Uro-Oncologist, Apollo Hospital Gurugram
Part 8 of 10 in Diagnosis and Management of Prostate Cancer
TURP: How Often It Can Be Repeated, and the Real Tradeoff
July 7, 2024
TURP (transurethral resection of the prostate) is a mainstay surgical treatment for BPH, and a direct question during the session addressed how often it can realistically be repeated on the same patient.
How often TURP needs to be repeated
About 10 out of 100 patients will need another TURP within the following 10 years. There is no fixed limit on how many times it can be done, sometimes the prostate regrows quickly and requires re-intervention, and in some cases the procedure is deliberately staged, half the prostate resected in one operation, the rest in a later one. Dr. Shrivastava's own personal maximum has been twice on the same patient.
The real tradeoff with repeat procedures
While there's no hard cap on repeat TURP, the more times it's performed on the same patient, the higher the chance of complications. This is the practical consideration that should guide the conversation with a patient facing a potential repeat procedure, not an arbitrary limit.
This article is based on a Jivo Masterclass session conducted by Dr. Nitin Shrivastava, Consultant, Urology and Uro-Oncology, Artemis Hospital, Gurgaon (his affiliation at the time of this session). The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr.Nitin Shrivastava taught doctors across Africa on July 7, 2024.
FROM THE LIVE Q&A
Moderator
What is a neobladder? What is an ileal conduit? How will treatment affect my quality of life?
Dr.Nitin Shrivastava
Neobladder and ileal conduit are treatments for bladder cancer, not prostate cancer. A neobladder is an artificial bladder made from the patient's intestine, stitched together so the patient continues to pass urine through their natural passage. An ileal conduit instead diverts urine to exit through a different passage into a bag. On quality of life: what matters most in the long run is that the cancer comes out of the body completely; patients adjust well to either option over time.
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Frequently Asked Questions
Is there a limitation on the number of times TURP can be done on the same patient?▼
About 10 out of 100 patients will require another TURP within the following 10 years. There is no fixed limit, sometimes the prostate regrows fast and requires re-intervention, and sometimes it's done in stages. The more times TURP is repeated, the higher the chance of complications. Personally, the doctor has done it twice at most on the same patient.
CT scan is more accessible in our setup than MRI. Is there any place for CT to confirm prostate cancer?▼
CT scan cannot be used to confirm prostate cancer diagnosis, only MRI can do that. But if MRI isn't available, CT scan is very useful for staging: once a cancer diagnosis is confirmed by biopsy, CT can tell you if it has spread outside the prostate.
What is the value of PSA to consider dangerous: free PSA, total PSA, PSA ratio?▼
PSA density above 0.15 is suspicious for cancer. A PSA rise of more than 0.75 per year is also suspicious. These are used alongside the age-adjusted PSA cutoffs (2.5 / 3.5 / 4.5 / 6.5 for the 40s / 50s / 60s / 70s age bands) when a single reading is borderline.
In case of BPH, what age range is surgery recommended instead of just urine diversion or catheterization?▼
It is not age but fitness for the procedure that matters. The doctor has operated on a 100-year-old patient, while some patients who are only 60 have too many other diseases and are too high-risk for surgery, and stay on a catheter instead. If a patient has a large prostate requiring long surgery and is high-risk, the choice to proceed with surgery understanding the risk ultimately becomes the patient's own.
After removal of prostate cancer, there is urine leakage. What is the remedy?▼
The most practical and best remedy is rehabilitation through Kegel exercises, pelvic floor muscle exercises. If these exercises don't help, an artificial urinary sphincter surgery is available, but that is the last resort.
How often does TURP need to be repeated?▼
About 10% of patients need another TURP within 10 years. There's no fixed limit on repeats, though more repeat procedures raise the chance of complications.
Why might TURP be done in stages?▼
Sometimes half the prostate is resected in one operation and the rest in a later one, particularly for larger prostates or higher-risk patients.
In This Series: Diagnosis and Management of Prostate Cancer
- 1.Diagnosis and Management of Prostate Cancer
- 2.Why Physical Examination Still Matters in Prostate Cancer
- 3.PSA Testing: Age-Adjusted Thresholds, Density and Velocity
- 4.Who Needs Earlier Prostate Cancer Screening
- 5.When to Biopsy: Balancing Missed Cancer Against Overtreatment
- 6.Biopsy Technique and Imaging: Transrectal vs Transperineal, CT vs MRI
- 7.Managing BPH: From Lifestyle to Alpha-Blockers to Surgery
- 8.TURP: How Often It Can Be Repeated, and the Real Tradeoff
- 9.After Prostate Surgery: Incontinence, Neobladder and Quality of Life
- 10.Nutrition and Multidisciplinary Care in Prostate Cancer