UROLOGICAL ONCOLOGY

Post-brachytherapy transurethral resection of the prostate in patients with localized prostate cancer
Flam TA, Peyromaure M, Chauveinc L, Thiounn N, Firmin F, Cosset JM, Bernard D.
Department of Urology, Hopital Cochin, Paris, France
J Urol. 2004; 172: 108-11

• Purpose: We assessed the rate and results of transurethral resection of the prostate (TURP) in patients previously treated with brachytherapy as monotherapy for localized prostate cancer.
• Materials and Methods: From May 1998 to May 2003, 600 patients with localized prostate cancer were treated with brachytherapy at our institution. Brachytherapy was performed as monotherapy with curative intent for clinically localized prostate cancer without adjuvant treatment in patients with clinical stages T1c (68.4%) or T2a (31.6%) disease. -Iodine and palladium implants were used in 583 and 7 patients, respectively. A real-time interactive implantation technique was used in all but the first 17 patients, who were treated using a preplanned technique.
• Results: Of the 600 patients 19 (3.1%) underwent TURP after brachytherapy. Among the patients with acute urinary retention the median interval between prostate brachytherapy and urinary retention was 2 months (range 0.5 to 32). No TURP was done within 6 months after implant. The median interval between prostate brachytherapy and TURP was 7 months (range 6 to 41) and median prostate specific antigen (PSA) before TURP was 0.5 ng/ml (range 0.04 to 3.4). In the 19 patients the median weight of resected prostatic tissue was 8 gm (range 2 to 19) and 1 to 11 seeds were removed (median 5). The perioperative and postoperative courses were uneventful. There was no TURP related incontinence. With a median followup of 28 months after brachytherapy (range 7 to 48) no patient had clinical or biochemical evidence of disease progression, and for the group of 19 patients who underwent TURP median serum PSA at the end of followup was 0.38 ng/ml (range 0.03 to 3.4).
• Conclusions: After brachytherapy as monotherapy, TURP can be done safely if indicated. In our experience the resection of prostatic tissue along with a limited number of seeds at least 6 months after implantation did not impair PSA based biological and clinical results of brachy-therapy.
  
  
• Editorial Comment
  In rare instances TUR-P is necessary after brachytherapie for prostate cancer. According to the literature there is a high risk of incontinence in these patients. The authors addressed this point and stated that there is no major risk of of TUR-P related incontinence after brachytherapy.
  Even more interestingly, pathological examination of resected tissue showed mostly fibrumuscular tissue with rare atrophic prostatic glands and no evidence of cancer in all patients except for one, who had persistent prostate cancer with gleason score of 8 on the TUR-P specimen 7 months after brachytherapy, thus contradicting for brachytherapy previous notes on external beam radiation that viable tumor tissue is detectable long-term after irradiation.

Dr. Andreas Böhle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany