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Is There an Increase in Genitourinary Toxicity in Patients Treated With Transurethral Resection of the Prostate and Radiotherapy?: A Systematic Review

Ishiyama, Hiromichi MD*,†; Hirayama, Takahiro MD‡,§; Jhaveri, Pavan MD; Satoh, Takefumi MD, PhD§; Paulino, Arnold C. MD*; Xu, Bo MD, PhD*; Butler, Edward Brian MD*; Teh, Bin S. MD*

American Journal of Clinical Oncology: June 2014 - Volume 37 - Issue 3 - p 297–304
doi: 10.1097/COC.0b013e3182546821
Review Articles

Purpose: Transurethral resection of the prostate (TURP) is considered by some as a risk factor for genitourinary (GU) toxicity after radiotherapy (RT). However, there are conflicting results regarding the interaction between RT and TURP with respect to GU toxicity. The purpose of this report is to review the published data concerning TURP before or after RT and its effect on urinary complication.

Methods and Materials: A systematic literature review based on database searches in MEDLINE, EMBASE, Pubmed, Ovid, and Chochrane Library. The eligibility criteria of final review were (1) definitive RT for prostate cancer is reported; (2) comparison of GU toxicities between patients with and without TURP is reported; (3) minimum 5 patients after TURP are included.

Results: Twelve articles regarding overall GU toxicity, 15 articles regarding urinary incontinence, and 13 articles regarding urinary or bladder neck stricture met eligibility criteria, and they were included in the final review. A quantitative synthesis from the data of selected articles was impossible because of variable grading systems and variable definitions in their comparisons between patients with and without TURP. However, most published articles demonstrated the increased risk of GU toxicity with TURP in patients treated with RT.

Conclusions: Our systematic review strongly suggests that TURP is one of the risk factors of GU toxicity after RT. This needs to be taken seriously when prostate cancer patients with TURP are considered for RT either external beam or brachytherapy.

*Department of Radiation Oncology, The Methodist Hospital, Cancer Center, and Research Institute

Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, University of Texas

Department of Radiology, Baylor College of Medicine, Houston, TX

Departments of Radiology and Radiation Oncology

§Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan

The authors declare no conflicts of interest.

Reprints: Bin S. Teh, MD, Department of Radiation Oncology, The Methodist Hospital Cancer Center, 6565 Fannin, Ste # DB1-077, Houston, TX 77030. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc