Poster Presentation – Abstracts Archive

UK & Ireland Prostate Brachytherapy Conference 2013

Abstract number 13

Median Lobe Resection Followed by Delayed Permanent Seed Prostate Brachytherapy: A Retrospective Analysis of Urinary Toxicity

Kasia Owczarczyk
The Royal Free Hospital
Juan Vilarino-Varela
The Royal Free Hospital
David Eaton
The Royal Free Hospital
Amir Kaisary
The Royal Free Hospital
Katherine Pigott
The Royal Free Hospital
Maria Vilarino-Varela
The Royal Free Hospital

Aims/Introduction: Median lobe resection (MLR) prior to permanent seed prostate brachytherapy (PSPB) may be considered for patients with high baseline International Prostate Symptom Score (IPSS) and median lobe hyperplasia. When carried out immediately prior to PSPB it is associated with high rates of urinary retention⁽¹⁾. We conducted a retrospective institutional audit of functional outcomes, following a two-step approach, whereby PSPB (performed utilising peripheral loading of seeds and real-time dosimetry) is delayed by 3 months after MLR.

Materials/Methods: Data was collected retrospectively on 13 patients treated at the Royal Free Hospital between 2009 and 2010. Serial PSA readings and IPSS were extracted from patient files. All patients received follow-up telephone consultation to verify IPSS.

Results: All patients fulfilled criteria for PSPB. Mean baseline IPSS was 10.2 (1-20) with 76% being IPSS 8. Median time from MLR to PPSB was 116 days (82-181). Mean intra-operative prostate volume (PV) was 31cc (10-62); mean post-implant D90 was 176Gy (163-187), mean post-implant V100 was 94% (91-96).

At 3 months post brachytherapy, one patient reported severe (IPSS 20-35) and two patients reported moderate (IPSS 8-19) urinary symptoms.

During a median follow-up of 40 months (29-50) two patients developed urethral strictures, five had mild urinary toxicity (IPSS 1-7) and six were symptom-free at last follow-up. No biochemical PSA relapses were observed.

Patients with poor functional outcomes had significantly larger PV at implantation (median 51cc versus 23.5 in patients with mild LUTS and 33.8cc in patients with no LUTS, p=0.04)

Conclusions: This single-centre experience suggests MLR followed by delayed brachytherapy with real time dosimetry is a relatively well-tolerated option for patients fulfilling the criteria for PSPB but presenting with high IPSS due to median lobe hyperplasia. The observed urethral stricture rate in this patient cohort was 15%, with risk confined to patients with high PV at implantation.

References:

Cosset JM, et al. Brachytherapy. 2011;10(1):29-34.