Special Report: ASTRO 02: 44th Annual Meeting of the American Society for Therapeutic Radiology and Oncology, October 6–10, New Orleans
NEW ORLEANS—A history of undergoing transurethral resection of the prostate (TURP) does not preclude brachytherapy for treatment of prostate cancer. That was the conclusion of a review of urinary outcome data in more than 100 patients treated with radiation therapy after TURP, as presented here at the American Society for Therapeutic Radiology and Oncology Annual Meeting.
Brachytherapy patients previously treated with TURP had follow-up urinary function and “bother” scores that compared favorably with scores for brachytherapy patients who did not have prior TURP, reported Brian J. Moran, MD, a radiation oncologist at the Chicago Prostate Cancer Center in Westmont, IL.
“With accurate ultrasound identification of the urethral defect and careful planning, brachytherapy can be performed in patients who have had prior TURP with resultant low impact on urinary function and bother.”
American Urological Association (AUA) symptom scores can be used to stratify TURP patients with respect to their risk of post-radiation urinary symptoms, he added.
“If we can identify the defect, we can use modern radiation therapy planning systems to avoid the defect, and that is critical to reducing the risk of urinary symptoms.”
At the height of its popularity in the 1980s, TURP was the most common genitourinary procedure, peaking at 400,000 cases annually. Introduction of effective medical therapies for benign prostatic hyperplasia diminished TURP's role, and the number of procedures has declined to fewer than 100,000 a year, Dr. Moran noted.
TURP patients have an incontinence prevalence of 1% to 2%. However, incontinence rates as high as 24% have been reported in TURP patients who undergo brachytherapy for prostate cancer.
“If we look at reports in the literature, TURP has been considered a relative contraindication to brachytherapy for prostate cancer,” said Dr. Moran. “However, if we look at those earlier publications, they did not have the advanced treatment planning systems we have today. If we can identify the defect, we can use modern radiation therapy planning systems to avoid the defect, and that is critical to reducing the risk of urinary symptoms.”
Dr. Moran retrospectively evaluated 118 patients with a history of TURP and subsequent brachytherapy for Stage T1a-T2b prostate cancer. The mean AUA symptom score prior to radiation treatment was 7.75, and the patients were followed for a median of two years after brachytherapy (range of 6–51 months).
Continence was assessed by means of the UCLA PCI Urinary Function and Bother scales. Almost 70% of the men said they leaked urine less than once a week or not at all, and 98% said they had total urinary control or had only occasional dribbling.
Additionally, 90% said they did not use absorbent pads or did not need pads or diapers. The patients had a mean urinary function score of 83.9 and a mean bother score of 82, which proved to be better than scores for published historical control groups of radical prostatectomy patients and brachytherapy patients with no history of TURP.
By multivariate logistic regression analysis, only the pretreatment AUA symptom score predicted urinary function and urinary bother scores after brachytherapy. An AUA score of 8 or less was associated with fewer urinary function and bother symptoms.
Coverage of this year's ASTRO Annual Meeting, which started in last month's issue, continues here with these reports of some of the most interesting and clinically important findings