OBJECTIVE: To report the urinary toxicity outcomes for patients at greater risk of voiding symptoms and retention who received a modified transurethral resection of the prostate (TURPBXT) prior to low-dose rate brachytherapy (BXT).
PATIENTS AND METHOD: Data were analysed from patients receiving the above procedures between 2006 and present, taken from the prospective brachytherapy database of 2,000 patients at the St. Luke's Cancer Centre. The TURPBXT was performed at a median of 64 days (25, 205 days) before implantation with a median resection weight of 1.15 grams. Selection criteria were based on patients suffering from moderate LUTS, poor flow or post-void residual, or a prominent middle lobe or high bladder neck on TRUS. Baseline prostate cancer characteristics, uroflowmetry, IPSS and QoL scores were collected and compared to follow-up IPSS and QoL data.
RESULTS: Data for 112 patients was gathered from the database. The TURPBXT demonstrated statistically significant improvements before brachytherapy in Qmax and post void residual, IPSS and QoL scores (Qmax of 16.7 vs 11.3 mls/sec pre- TURPBXT). IPSS and QoL scores post-implant were found to be increased compared to pre-TURPBXTat 6 months (mean IPSS 11.7 vs 9.8 pre- TURPBXT), but no difference at 1 year (mean IPSS 9), and improved scores at 2, 3, 4 and 5 years follow-up (mean IPSS of 7.9, 5.6, 5.3 and 7.4, respectively).
CONCLUSION: This study suggests patients at increased risk of deteriorating voiding symptoms, including urinary retention, are no longer contraindicated against brachytherapy if they receive a limited pre-implant TURPBXT. This procedure does not appear to carry the risk of urinary incontinence thought to be associated with a conventional TURP prior to brachytherapy.
Written by:
Brousil P, Hussain M, Lynch M, Laing RW, Langley SE. Are you the author?
St. Luke's Cancer Centre, The Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey GU2 7XX, United Kingdom.
Reference: BJU Int. 2014 May 6. Epub ahead of print.
doi: 10.1111/bju.12798
PubMed Abstract
PMID: 24802744
