Is previous transurethral resection of the prostate a contraindication to brachytherapy

Abstract

Purpose/Objective: To evaluate the incidence of urinary incontinence and urinary bother after prostate brachytherapy (PB) in patients who have had prior transurethral resection of the prostate (TURP). Materials/Methods: Between October 1997 and August 2001, 171 patients (1997 AJCC) Stage T1a-T2b, Gleason Grade ≤7 who underwent prior TURP received PB as monotherapy at a single institution. All patients were mailed the University of California-Los Angeles Prostate Cancer Index (UCLA PCI) to assess their urinary function. 102 surveys were returned for an overall response rate of 60%. 2 respondents did not complete at least 80% of the survey and were therefore excluded. Time of TURP ranged from 2 to 300 months (median 6.5 yrs, mean 7.7 yrs) before implant. 8 patients had more than one TURP prior to implant. Mean patient age was 74±5.2 yrs. Follow-up ranged from 6.1 to 50.9 months (median 25 months). 59% received Amersham 6711 125I implant (144 Gy TG-43) while 41% received Theragenics 200 103Pd (132 Gy NIST 99). 31% had neoadjuvant Total Androgen Blockade (TAB) for downsizing. Brachytherapy was performed using a 3-D volume reconstructed preplanned/preloaded needle technique. Special care was taken in all cases to identify the urethral defect and avoid 150% of the prescribed matched peripheral dose to this site. Results: UCLA PCI urinary function and bother scores for all 100 patients were analyzed (Table 1). The mean urinary function score and bother score for the entire study group was 83.5±19.5 and 82.5±23.7, respectively. The mean urinary function scores for patients treated with Iodine vs. Palladium were 88.3±16.3 vs. 76.6±21.8, p = .003 and the mean bother scores for patients treated with Iodine vs. Palladium were 87.7±19.3 vs. 75.0±27.4, p = .008. T-tests were performed using the following grouping variables: age≥74 yrs, use of TAB, 125I vs. 103Pd and time to follow-up ≥25 months. The isotope used was the only variable that showed a significant difference in urinary function and bother scores. Conclusions: The majority of patients experienced little or no problem with urination. Specifically, only 3% of patients reported a moderate or big problem with dripping urine and 7% reported a moderate or big problem in urinary function bother (Table 1). Tabled 1Total No. Pts (%)How often leaked urine:Not at all51 (51)Less than once a week17 (17)About once a week10 (10)Every day22 (22)Best description of urinary control:Total control54 (54)Occasional dribbling45 (45)Frequent dribbling1 (1)No control whatsoever0 (0)Pads or adult diapers used daily to control leakage:Not Needed77 (77)No Pads14 (14)1–2 pads per day9 (9)3 or more pads per day0 (0)How big a problem is dripping urine or wetting pants:No problem57 (58)Very small problem23 (23)Small problem16 (16)Moderate problem2 (2)Big problem1 (1)Missing response1How big a problem is urine leakage interfering with sexual activity:No problem78 (91)Very small problem5 (6)Small problem1 (1)Moderate problem0 (0)Big problem2 (2)Missing response14Overall urinary function bother:No problem55 (55)Very small problem28 (28)Small problem10 (10)Moderate problem6 (6)Big problem1 (1)Quality of life scale ranges from 0–100 with higher scores representing better outcomes. Percentage of each item may not equal 100% due to rounding. For items with missing responses, valid percentage is reported. Open table in a new tab Quality of life scale ranges from 0–100 with higher scores representing better outcomes. Percentage of each item may not equal 100% due to rounding. For items with missing responses, valid percentage is reported.