BERKELEY, CA (UroToday.com) - The aim of the study was to evaluate the impact of transurethral resection of the prostate (TURP) on quality of life after external beam radiotherapy for prostate cancer. A history of prior surgery can predispose for acute and late toxicity after radiotherapy. Both TURP and radiation can cause pathophysiological changes in urothelial tissue, with possible additive effects on late toxicity. TURP is performed in a substantial number of older men who can be candidates for EBRT, sometimes many years later, in case of a prostate cancer diagnosis. Bothersome LUTS due to BPH affect 30% of men over 50 years of age.
Quality of life studies evaluating the effect of TURP have not been published. In contrast to toxicity grading systems, quality of life questionnaires give information from the perspective of patients. Baseline symptoms can only be accurately taken into account in a quality of life evaluation. They are usually ignored in studies using grading systems.
To analyze the effect of prior TURP on quality of life changes, this study has focused particularly on a matched-pair analysis comprising two patient groups with the same radiotherapy treatment technique, same fraction and total dose, comparable age, planning target volume (prostate with safety margins), and hormonal therapy concept. A group of 49 consecutive patients with, and 487 without prior transurethral resection responded to the Expanded Prostate Cancer Index Composite questionnaire before, at the last day, and a median time of 2 months and 16 months after external beam radiotherapy (70-78Gy).
TURP has a significant effect on radiotherapy-associated urinary toxicity. Significantly smaller acute urinary score changes relative to baseline levels resulted with vs without prior transurethral resection of the prostate (mean function/bother score decrease of 3/6 vs 18/21 points at the end of radiotherapy; p < 0.01), affecting urinary incontinence (pads to control urinary leakage in 4% vs. 24%; p=0.03) and irritative/obstructive symptoms (big/moderate problem with weak urinary stream in 11% vs. 37%; p=0.02). A weaker, but significant beneficial effect on acute bowel problems resulted additionally.
As opposed to acute changes, transurethral resection of the prostate was a significant predisposing factor for a long-term urinary function score decrease > 10 points (20% vs 6% of patients with vs without prior resection; p=0.04). Urinary incontinence risk was higher for patients with a longer time from resection to radiotherapy. As the distance between the sphincter muscle and urethral wall after resection could be significantly decreased, necrosis and accompanying inflammation of the urethral wall could affect the function of the sphincter muscle.
Written by:
Michael Pinkawa, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Radiation Oncology, Rheinisch-Westfaelische Technische Hochschule Aachen University, Pauwelsstrasse 30, 52057 Aachen, Germany
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