Many localized prostate cancer (PCa) patients with preexisting lower urinary tract symptoms (LUTS) are considered poor candidates for brachytherapy. In this study, 38 localized PCa patients with LUTS were safely treated with deferred limited transurethral resection of the prostate (LTURP) 6 months after brachytherapy. These results suggest that LUTS does not necessarily exclude patients from prostate brachytherapy.Introduction/Background:
Many localized PCa patients with preexisting LUTS are considered poor candidates for seed implants because of the greater risk of postoperative urinary morbidity. We report our department's experience with performing deferred LTURP 6 months after iodine-125 seed implantation to treat localized PCa patients with LUTS.Patients and Methods:
Of 225 men undergoing prostate brachytherapy at our institution between 2005 and 2011, 38 patients were treated with deferred LTURP 6 months after 125I seed implantation. LTURP was considered after brachytherapy for patients whose International Prostate Symptom Score (IPSS) was greater than 12, or who still need a catheter for an elevated postvoid residual (PVR) (>100 mL) after α-blocker therapy for LUTS for 6 months. IPSS, quality of life (QOL) score, peak flow rate (PFR), and PVR were evaluated before and after LTURP.Results:
All 38 patients in our series underwent LTURP 6 months after prostate brachytherapy for low- or intermediate-risk PCa. Mean IPSS, QOL score, PFR, and PVR were significantly improved after LTURP, and improvement persisted at the latest follow-up. After a mean of 32 months of follow-up, no patient developed retention, urethral necrosis, or urinary incontinence after brachytherapy and LTURP.Conclusion:
Iodine-125 seed implantation and deferred LTURP 6 months after brachytherapy is a safe and effective treatment strategy for patients with both LUTS and localized prostate cancer.