Abstracts Archive

UK & Ireland Prostate Brachytherapy Conference 2012

Abstract number 1

Dispelling the Myth: TURP Does Not Cause Post-BXT Incontinence or Prevent Adequate Implant

Dr Eliot Chadwick
St Luke’s Cancer Centre, Royal Surrey County Hospital
Mr Saqib Javed
Dept. of Urology, Royal Surrey County Hospital
Dr Robert Laing
St Lukes Cancer Centre, Royal Surrey County Hospital
Prof Stephen Langley
Dept. of Urology, Royal Surrey County Hospital

Aims / Introduction: Historically, patients with a high IPSS (>15), or a recent transurethral resection of the prostate (TURP), have been excluded from brachytherapy due to concerns regarding urinary incontinence, urinary outflow obstruction and the ability to achieve acceptable dosimetry. However, since 2006, a limited TURP/bladder neck resection (BNR) has been offered to such patients. The dosimetry, subsequent urinary function and biochemical relapse free survival (bRFS) are described here.

Materials / Methods: 65 Pre-implant brachytherapy patients with at least 32 months follow up, with obstructive uroflowmetry, together with a high bladder neck on TRUS were offered a BNR / limited TURP 6 weeks before their implant. IPSS scores were recorded prospectively on a bespoke database. A questionnaire based on the Expanded Prostate Cancer Index Composite (EPIC) questionnaire was sent to patients retrospectively to assess incontinence.

Results: Mean follow up was 47 months. 4 year bRFS was 97%. Mean post-implant D90 as a percentage of the prescribed dose was 112%. The percentage of patients with IPSS 0-8 was 55% pre-TURP and 77% at 3 years, whereas those with IPSS 17-35 were 9 and 3% pre-TURP and at 3 years respectively. No patient went into urinary retention or required intermittent self-catheterisation. The mean score for the EPIC incontinence domains was 93% and in particular, no-one was using pads.

Conclusion: A limited TURP / BNR is a procedure which can be performed on patients with urinary outflow obstruction who might not otherwise have been offered brachytherapy, and is preferable to a post-implant TURP when tissue healing is less predictable. A pre-implant TURP does not cause urinary incontinence and is associated with low urinary morbidity. The dosimetry and bRFS demonstrate that the oncological management is not compromised.