Is there an increase in genitourinary toxicity in patients treated with transurethral resection of the prostate and radiotherapy? A systematic review.
OBJECTIVE
Transurethral resection of the prostate (TURP) is considered by some as a risk factor for genitourinary (GU) toxicity after radiotherapy (RT). However, there are conflicting results regarding the interaction between RT and TURP with respect to GU toxicity. The purpose of this report is to review the published data concerning TURP before or after RT and its effect on urinary complication.


METHODS
A systematic literature review based on database searches in MEDLINE, EMBASE, Pubmed, Ovid, and Chochrane Library. The eligibility criteria of final review were (1) definitive RT for prostate cancer is reported; (2) comparison of GU toxicities between patients with and without TURP is reported; (3) minimum 5 patients after TURP are included.


RESULTS
Twelve articles regarding overall GU toxicity, 15 articles regarding urinary incontinence, and 13 articles regarding urinary or bladder neck stricture met eligibility criteria, and they were included in the final review. A quantitative synthesis from the data of selected articles was impossible because of variable grading systems and variable definitions in their comparisons between patients with and without TURP. However, most published articles demonstrated the increased risk of GU toxicity with TURP in patients treated with RT.


CONCLUSIONS
Our systematic review strongly suggests that TURP is one of the risk factors of GU toxicity after RT. This needs to be taken seriously when prostate cancer patients with TURP are considered for RT either external beam or brachytherapy.
*Department of Radiation Oncology, The Methodist Hospital, Cancer Center, and Research Institute ‡Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, University of Texas ∥Department of Radiology, Baylor College of Medicine, Houston, TX Departments of †Radiology and Radiation Oncology §Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
Hiromichi
H
Ishiyama
Takahiro
T
Hirayama
Pavan
P
Jhaveri
Takefumi
T
Satoh
Arnold C
AC
Paulino
Bo
B
Xu
Edward Brian
EB
Butler
Bin S
BS
Teh
D001918:Brachytherapy / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000150:complications / Q000209:etiology; D006801:Humans; D053685:Laser Therapy; D008297:Male; D011470:Prostatic Hyperplasia / Q000628:therapy; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D011832:Radiation Injuries / Q000150:complications* / Q000209:etiology; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects* / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D020728:Transurethral Resection of Prostate / Q000009:adverse effects*; D014521:Urethra / Q000293:injuries* / Q000473:pathology / Q000528:radiation effects*; D014555:Urination Disorders / Q000209:etiology* / Q000517:prevention & control; D014566:Urogenital System / Q000293:injuries / Q000528:radiation effects