title: Two-step transurethral surgery of the prostate and permanent implant brachytherapy for patients with lower urinary tract symptoms and low- to intermediate-risk prostate cancer.
abstract: OBJECTIVE
  Prostate brachytherapy is an increasingly used treatment option for low- to intermediate-risk prostate cancer (PCa). However, patients with preexisting lower urinary tract symptoms (LUTS) and PCa, who would otherwise be good brachytherapy candidates, are often contraindicated because of the risk of postoperative urinary morbidity. We report our clinical experience with limited transurethral resection of the prostate (LTURP) and/or transurethral incision of the prostate (TUIP) months before brachytherapy to treat patients with LUTS and low- to intermediate-risk PCa.
  
  
  METHODS
  Of 258 men undergoing prostate brachytherapy at our institution between 1998 and 2011, 42 were treated with planned LTURP and/or TUIP well before (mean, 5.7 months) seed implantation. Transurethral surgery was considered before brachytherapy for patients who at presentation required α-blocker therapy for LUTS, had an International Prostate Symptom Score greater than 14 off α-blockers, or had an elevated postvoid residual (>100 mL). Patients only proceeded to brachytherapy once LUTS resolved.
  
  
  RESULTS
  All 42 patients in our series underwent TUIP (25), LTURP (7), or TUIP/LTURP (10) with mean 5.7 months before prostate brachytherapy for low- or intermediate-risk PCa. Mean International Prostate Symptom Score, peak flow rate, and postvoid residual significantly improved after transurethral surgery, and improvement persisted at the latest followup. No patient developed retention, urethral necrosis, or urinary incontinence after transurethral surgery or brachytherapy (median followup, 39 months and range, 1-121).
  
  
  CONCLUSIONS
  Planned LTURP and/or TUIP more than 4 months before brachytherapy is a safe and effective treatment strategy for men with LUTS and low- to intermediate-risk PCa.
authors.affiliation: Department of Urology, Carolinas Medical Center, Charlotte, NC, USA. allie.ivanowicz@gmail.com
authors.forename: Allie N
authors.initials: AN
authors.lastname: Ivanowicz
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Wakeman
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Hubbard
authors.forename: William B
authors.initials: WB
authors.lastname: DeVoe
authors.forename: Michael R
authors.initials: MR
authors.lastname: Haake
authors.forename: Chris M
authors.initials: CM
authors.lastname: Teigland
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000295:instrumentation / Q000706:statistics & numerical data*; D015897:Comorbidity; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D009657:North Carolina / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D011468:Prostatectomy / Q000379:methods / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000532:radiotherapy*; D019736:Prostheses and Implants / Q000706:statistics & numerical data; D019919:Prosthesis Implantation / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery; D014570:Urologic Diseases / Q000453:epidemiology*