Role of transurethral resection of the prostate in population-based prostate cancer incidence rates

The extensive pool of asymptomatic prostate disease in the population, which increases substantially with age, suggests that the frequent use of transurethral resection of the prostate (TURP) in recent decades has had a large effect on prostate cancer incidence. The authors identified the effect of TURF-detected prostate cancer on the observed incidence rates between 1973 and 1993 for men aged 65 years and older. They linked population-based cancer registry data from the Surveillance, Epidemiology, and End Results Program to Medicare records between 1986 and 1993 to determine whether a TURF occurred sufficiently close to the time of a prostate cancer diagnosis for them to assume that it led to the diagnosis. TURF-detected cases prior to 1986 were calculated using an indirect method that involved multiplying the TURF procedure rate in the general population (from the National Hospital Discharge Survey) by estimates of the proportion of TURPs resulting in a prostate cancer diagnosis (from Medicare data and the literature). TURF explained much of the observed increase in overall prostate cancer Incidence between 1973 and 1986 and possibly all of it in men aged 70 years and older. However, its influence on the trend and overall magnitude of the rates diminished between 1987 and 1993. The changing role of TURF in detecting prostate cancer is attributed to changes in medical technology and screening practices. The declining influence of TURF on prostate cancer incidence is likely to have continued beyond the study period due to the recent introduction and increasing use of medications for treating obstructive uropathy.