ABSTRACT Objective To describe and compare the number of surgeries, mortality rate, length of hospital stay, and costs of transurethral resection of the prostate and open prostatectomy for the treatment of benign prostatic hyperplasia, between 2008 and 2018, in the Public Health System in São Paulo, Brazil. Methods Ecological and retrospective study using data from the informatics department of the Brazilian Public Health System database. Procedure codes were “open prostatectomy” and “transurethral resection of the prostate.” The outcomes analyzed were compared between transurethral resection of the prostate and open prostatectomy according to the hospital surgical volume and presence or absence of a residency program. Results A total of 18,874 surgeries were analyzed (77% transurethral resection of the prostate) and overall mortality was not statistically different between procedures. Intermediate and high-volume centers had shorter length of hospital stay than low-volume centers for transurethral resection of the prostate (3.28, 3.02, and 6.58 days, respectively, p=0.01 and p=0.004). Length of hospital stay was also shorter for open prostatectomy in high-volume compared to low-volume centers (4.86 versus 10.76 days, p=0.036). Intrahospital mortality was inversely associated with surgical volume for transurethral resection of the prostate. Centers with residency program had shorter length of hospital stay considering open prostatectomy and less mortality regarding transurethral resection of the prostate. Open prostatectomy was 64% more expensive than transurethral resection of the prostate. Conclusion The findings suggest the importance of investing in specialized centers, which could be potential referral centers for surgical cases.

OBJETIVO: Avaliar a crioterapia percutânea como tratamento primário para o câncer de próstata de alto risco. PACIENTES E MÉTODOS: De outubro de 2000 a fevereiro de 2005, 21 pacientes com câncer de próstata de alto risco foram submetidos a 24 crioablações de próstata como tratamento primário. A mediana de idade dos pacientes foi de 70,9, e a média do PSA pré-tratamento de 19,5 ng/dl. O tempo de seguimento variou de 6 a 60 meses (mediana de 41 meses). RESULTADOS: Os índices de falha do PSA foram de 39% e 52,9% respectivamente aos 12 e 24 meses de seguimento. A sobrevida livre de doença em 5 anos foi de 42,8%. De maneira geral os índices de complicações foram baixos, com 8% de incontinência urinária e nenhum caso de lesão retal. Os índices de impotência foram de 96%. Em doze pacientes (57,2%) onde houve falha da crioablação, 7 (58,3%) apresentaram recidivas locais (biópsia positiva) e os demais recidiva a distância. CONCLUSÃO: A crioablação percutânea da próstata é um tratamento minimamente invasivo da próstata, seguro, porém ainda com resultados modestos em pacientes com câncer de próstata de alto risco, quando se considera a sobrevida livre de doença em 5 anos, havendo portanto necessidade de associação de outras modalidades terapêuticas no tratamento deste grupo específico de doentes.

PURPOSE: To evaluate percutaneous cryotherapy as a primary treatment option for high-risk prostate cancer patients. PATIENTS AND METHODS: From October 2000 to February 2005, 21 high-risk (Gleason e•8 and/or PSA > 10 and/or stage > T2a) prostate cancer patients underwent 24 percutaneous prostate cryoablation procedures. Patients' median age was 70.9, and the average pretreatment PSA was 19.5 ng/dL. The follow-up period ranged from 6 to 60 months (median, 41 months). RESULTS: The PSA failure rate was 39%, 52.9%, and 42.8% at 12, 24, and 60 months of follow-up, respectively. Overall complication rates were low, with 8% of urinary incontinence and no cases of rectal injury; however, 96% of erectile dysfunction occurred. The cryoablation procedure failed in 12 patients (57.2%); 7 (58.3%) of these were local failures (positive prostate biopsies). CONCLUSION: Percutaneous cryoablation of the prostate is a safe minimally invasive treatment, but it has poor PSA-free survival outcomes in high-risk prostate cancer patients.