Urinary incontinence in patients who have a TURP/TUIP following prostate brachytherapy.

PURPOSE: To determine urinary morbidity in patients who have transurethral resection of the prostate (TURP) after 125I brachytherapy. MATERIALS AND METHODS: A total of 109 patients with Stage T1-T2 prostatic carcinoma were treated with 125I implantation from 1991 through 1995. Ten patients underwent TURP/transurethral incision of the prostate (TUIP) after brachytherapy to relieve urinary obstruction refractory to nonsurgical management. RESULTS: Patients who developed refractory urinary retention had a slightly larger preimplant prostate volume than those who did not (62 vs. 54 ml; p = 0.16). Seven of the 10 patients developed some degree of permanent urinary incontinence following TURP/TUIP. Urinary incontinence was mild in three patients [Late Effects Normal Tissue Radiation Oncology Group (LENT) score = 1] and severe in four additional patients (LENT score = 3). There was no obvious relationship between the degree of incontinence and use of TURP vs. TUIP, amount of tissue resected, or time between brachytherapy and TURP/TUIP. In five patients for whom detailed urethral radiation dose information was available, the doses were higher than generally recommended. CONCLUSION: Permanent urinary incontinence is common in patients who require a TURP or TUIP after prostate brachytherapy. Its cause is apparently multifactorial and may include the degree of physical damage to the urinary sphincters and the radiation dose to the urethral region.

The effect of radiotherapy on urethral obstruction from carcinoma of the prostate.

OBJECTIVE: To assess the impact of radiotherapy on the relief of complete bladder outlet obstruction requiring catheterization secondary to prostatic carcinoma. PATIENTS AND METHODS: From a consecutive series of 151 patients treated with radiotherapy for localized carcinoma of the prostate, 19 (12.6%; median age 72 years, range 59-83) who had an indwelling catheter in situ at the time of irradiation because of urinary retention, were analysed retrospectively and grouped according to the stage and grade of tumour and the irradiation dose delivered. RESULTS: The catheter was removed following radiotherapy in all but two patients, who both had stage 4 tumours, and normal urinary function was restored. The grade and stage of tumour did not influence the duration of catheterization. The median time from completion of radiotherapy to catheter removal was 10 weeks (range 0-46). Recatheterization was required in two patients at 3 and 64 months after radiotherapy and three patients, including these two, required transurethral prostatectomy (TURP) to relieve outlet obstruction. CONCLUSION: Prostatic radiotherapy is effective in relieving bladder neck obstruction caused by prostate cancer. Most patients will achieve normal urinary function without requiring TURP after treatment.

Sarcoma of the prostate treated with radiotherapy.

Sarcoma of the prostate is a rare primary tumour in adults. We report a 73-year-old man who presented with urinary outflow obstruction. He had histologically proven prostatic sarcoma and probably derived some benefit from radiotherapy. A brief review of the literature is included.

Transurethral radiotherapy for benign prostatic hypertrophy-related urethral obstruction. Dosimetry, ethics, and preliminary results.

The aim of this study is to present our preliminary experience in treating BPH-related urine retention, resistant to other medical treatment, with transurethral brachytherapy. We also deal with dosimetric analysis so as to eliminate ethical concerns about the exposure of patients not suffering from cancer to a certain level of body irradiation. Patients suffering from BPH-related urethral obstruction were treated with two transurethral applications (three weeks apart) of Cs137 MDR, which delivered a total of 16 Gy, at 0.5 cm from the urethral walls (dose rate 5-7 Gy/h). The application was done under ultrasonographic observation. Dosimetric calculation of the radiation exposure of the human body during transurethral radiotherapy (TURT) was performed for patients suffering from prostate cancer and treated with external beam radiotherapy and a boost dose through transurethral brachytherapy. For this purpose we used TLDs on skin surface and dosimetric analysis of X-ray films. Five patients treated for BPH urethral obstruction presented no sign of acute toxicity. All of them were weaned of their indwelling catheter immediately after the end of the first application. Obstruction did not recur within 12-18 months of follow-up. The dose delivered outside the prostate ranges from 1-7 cG, depending upon location. Proximal rectal and bladder walls received 1-2 Gy, a dose that is far from inducing acute or late toxicity. The estimated risk for carcinogenesis is negligible, and the expected benefit for the quality of life transcends the risks. No ethical concern is justified for testing transurethral radiotherapy for BPH-related urethral obstruction. TURT seems to be effective and provides durable results. Further investigation is required.