title: Post-brachytherapy transurethral resection of the prostate in patients with localized prostate cancer.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Urology, Hôpital Cochin, Paris, France. thierry.flam@cch.ap-hop-paris.fr
authors.forename: Thierry A
authors.initials: TA
authors.lastname: Flam
authors.forename: Michaël
authors.initials: M
authors.lastname: Peyromaure
authors.forename: Laurent
authors.initials: L
authors.lastname: Chauveinc
authors.forename: Nicolas
authors.initials: N
authors.lastname: Thiounn
authors.forename: Francis
authors.initials: F
authors.lastname: Firmin
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Cosset
authors.forename: Debré
authors.initials: D
authors.lastname: Bernard
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate; D016055:Urinary Retention / Q000209:etiology / Q000601:surgery*