A history of transurethral resection of the prostate should not be a contra-indication for low-dose-rate 125I prostate brachytherapy: results of a prospective Uro-GEC phase-II trial

Abstract

Purpose: Early reports suggested that transurethral resection (TURP) prior to permanent seed brachytherapy (BT) results in high incontinence rates. Guidelines consider prior TURP as a contra-indication to treatment, but improvements in imaging and treatment planning may reduce this risk, and are investigated in this prospective study. Material and methods: 99 men with histologically proven low-to intermediate-risk, localized prostate cancer, with a history of TURP performed at least 3 months before BT procedure were enrolled. All patients received a permanent seed implant between March 2009 and June 2015. Intra-operative interactive planning was recommended to ensure optimal accuracy of seed placement during the procedure. No supplemental external beam was allowed. Target and organ at risk contouring, definition of clinical target volume (CTV), and dosimetric parameters followed the modified GEC-ESTRO guidelines for permanent seed implants, as described an earlier report of our group. Follow-up was scheduled every 3 months for the first year, and every 6 months afterwards, with minimum follow-up of 2 years. Study endpoints: The primary endpoint was the incidence of post-implant urinary incontinence. Secondary endpoints were the incidence of urinary and gastro-intestinal toxicity, the eventual impact on the sexual function, and the freedom from biochemical failure. Results: The median follow-up time for these 99 patients was 49 months (min. 24, max. 96). In this series, the incontinence rate was 2% after TURP + BT and 2% in case of TURP + BT + re-TURP, ending up with a total urinary incontinence rate of 4%. Acute and late urinary toxicities were extremely low. No significant late gastro-intestinal toxicity was seen, and the 5-year biochemical non-evidence of disease (bNED) was 93%. Conclusions: The excellent long-term results and low morbidity presented as well as many advantages of prostate brachytherapy over other treatments demonstrates that brachytherapy is an effective treatment for patients with transurethral resection and organ-confined prostate cancer.

Minimal channel GreenLight photovaporization before permanent implant prostate brachytherapy for patients with obstructive symptoms: Technically feasible and safe

“…Other authors did not specify any technical problem to perform the BrT procedure (12,22). Salembier et al in a multicenter prospective analysis showed that it was possible to respect dosimetry constraints for BrT after a previous TURP, what had already been suggested by Cesaretti et al (19,24,25).…”

“…In addition, urinary incontinence (UI) has been previously described as a major concern for patients who underwent TURP after BrT (11e17). History of TURP also used to be a relative contraindication because of increased risk for UI (or because of too large resected area for seed placement); however, experienced teams have conducted studies concluding that selected patients with prior TURP could undergo BrT without increased morbidity (18,19). Recent studies also suggest that patients with severe baseline lower urinary tract symptoms could safely undergo BrT by a skilled practitioner (20).…”

Editorial Comment to Tri‐modality therapy with i‐125 brachytherapy, external beam radiation therapy, and short‐term hormone therapy for high‐risk prostate cancer after holmium laser enucleation of the prostate

“…Recently, some studies have reported the clinical outcomes of the LDR brachytherapy for patients with PC with TUR history. A single‐arm prospective study showed favorable oncological outcomes and acceptable urinary toxicity in patients with low to intermediate‐risk PC 3 . In contrast, a higher frequency of urinary toxicities was observed in patients with TUR history compared with those without it 4,5 .…”

“…In contrast, a higher frequency of urinary toxicities was observed in patients with TUR history compared with those without it 4,5 . Additionally, the presence of a rim of the prostate tissue of at least 1 cm around the urethral defect at the posterolateral side was one of the inclusion criteria for seed implantation 3 …”

Editorial: The Evolving Landscape of Stereotactic Body Radiation Therapy for the Management of Prostate Cancer

“…For patients that fail alpha-1 adrenergic receptor antagonists and/or 5-alpha reductase inhibitor medication, Transurethral Resection of the Prostate (TURP) or a derived variant of this procedure, is often prescribed. The role of pretreatment TURP portending for genitourinary toxicity post definitive LDR brachytherapy or IMRT has been dismissed in select series (40)(41)(42)(43). The data regarding pre-existing TURP after SBRT is currently emerging, with mixed findings that appear dependent, in part, on dose (44,45).…”