title: Outcomes after photoselective vaporization of the prostate and transurethral resection of the prostate in patients who develop prostatic obstruction after radiation therapy.
abstract: OBJECTIVE
  To compare the need for repeat treatment or urinary diversion in patients undergoing transurethral resection of the prostate (TURP) compared with photoselective vaporization of the prostate (PVP) after brachytherapy or external beam radiation therapy (EBRT).
  
  
  METHODS
  The prostate cancer database of Cleveland Clinic includes 3600 patients who have undergone prostate brachytherapy and 2500 patients who have undergone EBRT. We cross-referenced these patients with the electronic medical record to identify patients who required PVP or TURP after radiation. The primary outcome was the need for any further intervention after PVP or TURP, including bladder neck incision, repeat TURP, or permanent supravesicular diversion.
  
  
  RESULTS
  Sixty of the 3600 patients (1.7%) required prostate reduction surgery after brachytherapy. Of these 60 patients, 19 of 40 (47.5%) who underwent TURP required further intervention, and 10 of 20 patients (50%) who underwent PVP required subsequent intervention. Twenty-eight of the 2500 patients (1.1%) required prostate reduction surgery after EBRT. Of these 28 patients, 5 of 18 patients (27.8%) who underwent TURP required further intervention, and 5 of 10 patients (50%) who underwent PVP required subsequent intervention. Following either type of radiation there was not a significant difference in the need for further treatment based on the type of surgery (P >.999 for brachytherapy; P = .412 for EBRT). The median time between radiation and prostate reduction surgery is 20.2 months (range, 14.6-27.6) after brachytherapy and 53.3 months (range, 27.5-53.3) after EBRT (P = .0005).
  
  
  CONCLUSIONS
  This study suggests that PVP and TURP are comparable in treating prostatic obstruction after brachytherapy or EBRT. However, obstruction after brachytherapy occurs earlier compared with after EBRT.
authors: Cleveland Clinic Lerner College of Medicine, Cleveland, OH.
authors: Benjamin
authors: B
authors: Abelson
authors: Radiation Oncology, Cleveland Clinic, Cleveland, OH.
authors: Chandana A
authors: CA
authors: Reddy
authors: Radiation Oncology, Cleveland Clinic, Cleveland, OH.
authors: Jay P
authors: JP
authors: Ciezki
authors: Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, OH.
authors: Kenneth
authors: K
authors: Angermeier
authors: Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, OH.
authors: James
authors: J
authors: Ulchaker
authors: Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, OH.
authors: Eric A
authors: EA
authors: Klein
authors: Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, OH. Electronic address: woodh@ccf.org.
authors: Hadley M
authors: HM
authors: Wood
mesh_terms: D000368:Aged; D001918:Brachytherapy; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000150:complications / Q000532:radiotherapy*; D019233:Retreatment; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology / Q000601:surgery*; D014547:Urinary Diversion