To compare the grade 3 genitourinary toxicity and oncological outcome for localized prostate cancer between high-dose-rate (HDR) brachytherapy and external beam radiation therapy (EBRT) alone in patients with previously undergone Transurethral resection of the prostate (TURP).
Materials and methods
From November 1998 to November 2008, 78 patients with a history of TURP underwent radiation therapy for localized prostate cancer. Of these, 59 were enrolled in this study. In this study, 34 patients underwent HDR brachytherapy and 25 patients underwent EBRT alone.
Grade 3 genitourinary complication was observed in 8.8 % of HDR brachytherapy group and 44 % in EBRT alone group. Five-year urinary incontinence rate was 2.9 % in HDR brachytherapy and 24 % in EBRT alone group. The results showed that significant higher incidence of grade 3 genitourinary complication (p = 0.003) and urinary incontinence was the most significant (p = 0.023) in the EBRT alone group. Five-year biochemical survival rate was 82.4 % in HDR brachytherapy group and 72.0 % in EBRT alone group (p = 0.396).
In patients with prostate cancer who have previously undergone TURP, we observed that HDR brachytherapy was able to control prostate cancer with fewer GU morbidities and oncological outcomes that were similar to those associated with traditional EBRT alone. Moreover, HDR brachytherapy led to a decrease in major GU toxicity and also preserved the sphincter function more than that in TURP patients who underwent EBRT alone.
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Blasko JC, Ragde H, Grimm PD (1991) Transperineal ultrasound-guided implantation of the prostate: morbidity and complications. Scand J Urol Nephrol Suppl 137:113–118
Talcott JA, Clark JA, Stark PC, Mitchell SP (2001) Long-term treatment related complications of brachytherapy for early prostate cancer: a survey of patients previously treated. J Urol 166:494–499
Peddada AV, Jennings SB, Faricy PO, Walsh RA 3rd et al (2007) Low morbidity following high dose rate brachytherapy in the setting of prior transurethral prostate resection. J Urol 178:1963–1967
Luo HL, Fang FM, Chuang YC, Chiang PH (2009) Previous transurethral resection of the prostate is not a contraindication to high-dose rate brachytherapy for prostate cancer. BJU Int 104:1620–1623
Demanes DJ, Rodriguez RR, Schour L, Brandt D et al (2005) High-dose-rate intensity-modulated brachytherapy with external beam radiotherapy for prostate cancer: California endocurietherapy’s 10-year results. Int J Radiat Oncol Biol Phys 61:1306–1316
Chiang PH, Fang FM, Jong WC, Yu TJ et al (2004) High-dose rate iridium-192 brachytherapy and external beam radiation therapy for prostate cancer with or without androgen ablation. Int J Urol 11:152–158
Fang FM, Wang YM, Wang CJ, Huang HY et al (2008) Comparison of the outcome and morbidity for localized or locally advanced prostate cancer treated by high-dose-rate brachytherapy plus external beam radiotherapy (EBRT) versus EBRT alone. Jpn J Clin Oncol 38:474–479
National Cancer Institute. Common terminology criteria for adverse events v.3.0and v.4.0 (CTCAE). Available at: http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm. Accessed 14 June 2011
Abrams P, Cardozo L, Fall M, Griffiths D et al (2003) The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology 61:37–498
van Andel G, Kurth KH (2003) The impact of androgen deprivation therapy on health related quality of life in asymptomatic men with lymph node positive prostate cancer. Eur Urol 44:209–214
Frank SJ, Pisters LL, Davis J, Lee AK et al. (2007) An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. J Urol 177:2151–2156; discussion 6
Del Regato JA (1967) Radiotherapy in the conservative treatment of operable and locally inoperable carcinoma of the prostate. Radiology 88:761–766
Sandhu AS, Zelefsky MJ, Lee HJ, Lombardi D et al (2000) Long-term urinary toxicity after 3-dimensional conformal radiotherapy for prostate cancer in patients with prior history of transurethral resection. Int J Radiat Oncol Biol Phys 48:643–647
Wallner K, Lee H, Wasserman S, Dattoli M (1997) Low risk of urinary incontinence following prostate brachytherapy in patients with a prior transurethral prostate resection. Int J Radiat Oncol Biol Phys 37:565–569
Zapatero A, Garcia-Vicente F, Sevillano D, Martín de Vidales C et al (2008) Is hormone therapy a protective factor for late hematuria after high-dose radiotherapy in prostate cancer? Urology 72:1130–1134
Strasser H, Tiefenthaler M, Steinlechner M, Bartsch G et al (1999) Urinary incontinence in the elderly and age-dependent apoptosis of rhabdosphincter cells. Lancet 354:918–919
Gundian JC, Barrett DM, Parulkar BG (1993) Mayo Clinic experience with the AS800 artificial urinary sphincter for urinary incontinence after transurethral resection of prostate or open prostatectomy. Urology 41:318–321
Liu M, Pickles T, Berthelet E, Agranovich A et al (2005) Urinary incontinence in prostate cancer patients treated with external beam radiotherapy. Radiother Oncol 74:197–201
Kollmeier MA, Stock RG, Cesaretti J, Stone NN (2005) Urinary morbidity and incontinence following transurethral resection of the prostate after brachytherapy. J Urol 173:808–812
Narayan P, Konety B, Aslam K, Aboseif S et al (1995) Neuroanatomy of the external urethral sphincter: implications for urinary continence preservation during radical prostate surgery. J Urol 153:337–341
de Almeida SM, da Cruz AD, Ferreira RI, Vizioli MR et al (2007) Effect of low-dose electron radiation on rat skin wound healing. Braz Dent J 18:208–214
Jaffe J, Stakhovsky O, Cathelineau X, Barret E et al. (2007) Surgical outcomes for men undergoing laparoscopic radical prostatectomy after transurethral resection of the prostate. J Urol 178:483–487; discussion 7
Menard J, de la Taille A, Hoznek A, Allory Y et al (2008) Laparoscopic radical prostatectomy after transurethral resection of the prostate: surgical and functional outcomes. Urology 72:593–597
Palisaar JR, Wenske S, Sommerer F, Hinkel A et al (2009) Open radical retropubic prostatectomy gives favourable surgical and functional outcomes after transurethral resection of the prostate. BJU Int 104:611–615
Conflict of interest
Authors declare no conflicts of interest.
Hao Lun Luo and Fu Min Fang contributed equally to this study.
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Luo, H.L., Fang, F.M., Kang, C.H. et al. Can high-dose-rate brachytherapy prevent the major genitourinary complication better than external beam radiation alone for patients with previous transurethral resection of prostate?. Int Urol Nephrol 45, 113–119 (2013). https://doi.org/10.1007/s11255-012-0277-y
- HDR brachytherapy
- External beam radiation therapy
- Transurethral resection of the prostate
- Genitourinary toxicity