One-step customized transurethral resection of the prostate and permanent implant brachytherapy for selected prostate cancer patients: technically feasible but too toxic.
BACKGROUND
Patients with prominent median lobe hyperplasia and/or high International Prostate Symptom Score (IPSS) are often contraindicated for prostate brachytherapy, mainly because of the risk of post-implant urinary retention. We evaluated an approach combining in the same operative step a limited transurethral resection (TURP) of the median lobe, immediately followed by permanent implant-free seed brachytherapy.


METHODS
From January 2007 to November 2008, 22 patients underwent a customized limited TURP of their median lobe immediately before brachytherapy. All patients fulfilled our criteria for permanent implant brachytherapy, but presented with a more or less prominent median lobe and/or a high IPSS.


RESULTS
The procedure appeared to be technically feasible, with only 0.3% of migrating seeds, a mean post-implant D90 of 173.4 Gy and a mean post-implant V100 of 96.6%. However, 5 patients (23%) experienced a urinary retention, with two patients having to undergo a complementary post-implant TURP. Moreover, urinary toxicity was more pronounced than in our current experience, with high IPSS at 2 months (mean 19.2) and 6 months (mean 15.8).


CONCLUSIONS
Although technically feasible, with relatively few migrating seeds and satisfactory post-implant dosimetric parameters, one-step TURP and brachytherapy was found to be poorly tolerated, with higher than usual urinary retention and urinary toxicity rates. Considering those results, our group is presently evaluating a two-step procedure, with a customized TURP followed after 4-6 months by brachytherapy.
Department of Radiotherapy, Institut Curie, 26 rue d’Ulm, Paris, France. Jean-marc.cosset@curie.net
Jean-Marc
JM
Cosset
Eric
E
Barret
Pablo
P
Castro-Pena
Xavier
X
Cathelineau
Marc
M
Galiano
François
F
Rozet
Noëlle
N
Pierrat
Michel
M
Timbert
Guy
G
Vallancien
D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D020728:Transurethral Resection of Prostate / Q000009:adverse effects / Q000379:methods*