诊断性前列腺电切23例临床分析

目的 评估诊断性前列腺电切(TURP)在前列腺穿刺活检阴性但仍怀疑前列腺癌(PCa)且伴有明显的前列腺增生(BPH)所致的下尿路症状的患者中的应用价值及意义.方法 对23例前列腺穿刺活检阴性且伴有明显的BPH所致的下尿路症状的患者行诊断性TURP,对结果进行分析.结果 23例患者中,术后病理论断为BPH的19例;诊断为PCa的4例,其中1例为PCa伴高级别前列腺上皮内瘤变(HGPIN).结论 诊断性TURP可作为诊断前列腺穿刺活检阴性且合并有明显的BPH所致的下尿路症状的患者的重要方法.且安全性高.     

经尿道前列腺电切术72例前列腺疾病应用分析

[目的]评价经尿道前列腺电切术（TURP）在检测前列腺癌中的作用。[方法]回顾性分析72例高度怀疑前列腺癌而活检阴性的患者行TURP术的临床资料。[结果]72例患者中病理诊断前列腺癌15例（占20.8%）。病理结果良性的患者,2例患者术后复查PSA异常,再次穿刺活检确诊前列腺癌。[结论]TURP术既是前列腺增生的治疗手段,也是一种前列腺癌的检测方法。     

联合雄激素阻断治疗中晚期前列腺癌

目的 探讨联合雄激素阻断治疗不宜手术根治的前列腺癌的疗效。方法 回顾性分析28例前列腺癌患者采用手术或药物去势联合雄激素阻滞剂氟他胺治疗的临床资料，并结合文献进行讨论。结果 联合雄激素阻断治疗可迅速降低患者血清睾酮及PSA，使前列腺体积缩小，临床症状缓解。结论 联合雄激素阻断治疗晚期前列腺癌更合理，也更有效。     

经尿道双极等离子电切术治疗前列腺癌的疗效观察

目的探讨经尿道双极等离子电切术(TKRP)治疗前列腺癌的临床效果。方法选取2012年2月至2013年2月间收治的62例前列腺癌患者,按照手术方式不同分为经尿道双极等离子电切术(TKRP)组和经尿道前列腺电切术(TURP)组,每组31例,观察两组患者治疗前后血清前列腺特异抗原(PSA)水平、残余尿量、国际前列腺症状(IPSS)评分及手术中相关指标。结果 62例患者手术治疗均取得成功,TKRP组患者治疗后的血清PSA水平、残余尿量、IPSS评分、最大尿流率等指标明显优于TURP组,差异有统计学意义(P<0.05)。结论对于中晚期前列腺癌患者采取姑息性双极等离子前列腺汽化电切术(PKRP)并结合抗雄性激素药物治疗,可以有效缓解前列腺癌导致的尿路梗阻,从而有效改善患者的生活质量。     

经尿道手术治疗伴有膀胱出口梗阻的前列腺癌

 目的　探讨前列腺癌致下尿路梗阻的治疗方法。方法　应用经尿道前列腺切除术对2 6例有后尿道梗阻的前列腺癌患者进行治疗。其中经尿道前列腺电切术 ( TURP) 1 7例 ,经尿道前列腺电汽化切割术 ( TUEVP) 9例 ,同时联合内分泌治疗。结果　 2 6例患者主、客观症状 ,最大尿流率 ,残余尿均较术前有明显改善。结论　对晚期前列腺癌致下尿路梗阻者 ,TURP和 TUEVP是安全可靠的姑息性治疗方法 ,在有效减少尿路梗阻所致并发症的同时可提高患者生活质量.     

经直肠超声引导前列腺穿刺活检术的应用价值

[目的]探讨经直肠超声引导下前列腺穿刺活检术对诊断前列腺疾病的临床应用效果.[方法]对163例临床怀疑前列腺癌患者,行经直肠超声引导前列腺穿刺活检术,并对结果进行回顾性统计分析.人选患者为前列腺特异性抗原(PSA)＞4μg/L,和(或)B超或直肠指检发现前列腺结节者.对于PSA在4～10μg/L者,结合游离PSA/总PSA比值(F/T),＜0.16者行穿刺术.前列腺穿刺活检取材方案为6～12针.[结果] 163例患者病理证实前列腺腺泡癌76例,良性前列腺增生58例,前列腺不典型增生16例,慢性前列腺炎症8例,前列腺内皮瘤形成5例.前列腺癌穿刺阳性率为46.6％.引入游离PSA/总PSA比值后,能提高PSA在4～10μg/L患者中的穿刺阳性率,但差异未达到统计学意义.术后并发症主要为血尿、大便表面带血、发热,发生率分别为45.4％、7.4％、1.8％.[结论]经直肠超声引导前列腺穿刺活检术安全有效,对前列腺癌早期诊断具有较高临床应用价值.结合PSA以及游离PSA/总PSA比值可以有效提高前列腺穿刺阳性率.     

高危前列腺癌合并膀胱出口梗阻的治疗

背景与目的:近年前列腺癌的发病率和检出率明显增加,尤其是高龄合并多种老年性疾病的患者增加,且常伴有严重的膀胱出口梗阻症状,患者生活质量大受影响。本文探讨高危前列腺癌合并膀胱出口梗阻患者的适宜治疗方案。方法:对80例高危前列腺癌合并膀胱出口梗阻的患者采取经尿道前列腺电汽化术 双侧睾丸切除术 抗雄激素内分泌治疗。术前对每个患者进行个体化准备,围手术期加强监护。术前及术后均对患者进行国际前列腺症状评分(internationalprosteticsymptomscore,IPSS),并测定最大尿流率(maximumofflow,Qmax)、血PSA及行B超检查以确定疗效。结果:80例患者均顺利手术。无尿潴留者术前、术后3个月IPSS分别为31±2、11±3,Qmax分别为(8.9±3.4)ml/s、(19.4±2.7)ml/s;尿潴留者术前、术后3个月IPSS分别为31±2、13±3,术后3个月Qmax为(19.0±3.3)ml/s。术前、术后IPSS、Qmax测定比较有显著性差异(P<0.01)。术后血PSA迅速下降,B超检查显示前列腺体积明显缩小。结论:经尿道前列腺电汽化术 双侧睾丸切除术 抗雄激素内分泌治疗对高危前列腺癌合并膀胱出口梗阻患者是一种安全有效的治疗方法。     

前列腺肿物检查方法的临床评价

目的评价血清前列腺特异性膜抗原（PSA）和各项物理检查对指导前列腺活检的意义。方法结合血清PSA、直肠指诊（DRE）、直肠B超（TRUS）及磁共振成像（MRI）检查,对148例可疑前列腺病变患者,经直肠B超引导下行前列腺穿刺活检。结果前列腺活检阳性率为43.9%（65/148）。DRE和PSA对前列腺癌的诊断有意义(P＜0.05),其中PSA加DRE、TRUS及MRI对前列腺癌的诊断明显高于PSA或DRE（P<0.01）,但前述三者之间对前列腺癌的诊断差异无显著性（P=0.46,P＝0.16,P＝0.52）。MRI的敏感性高于DRE和TRUS（P=0.05,P=0.01）,TRUS的特异性高于PSA或MRI（P=0.02,P=0.001）。结论前列腺活检是诊断前列腺癌的重要手段,其初步筛选以DRE加PSA为主,同时结合TRUS及MRI,可提高筛选的敏感性和特异性,避免不必要的活检。DRE或PSA加TRUS或MRI在前列腺活检筛选中可提高前列腺活检的阳性率。     

^125Ⅰ前列腺放射粒子植入术并发症分析

目的 探讨125I前列腺放射粒子植入术治疗前列腺癌的效果和并发症. 方法 前列腺癌患者72例,临床分期T2bN0M0至T3aN0M0期63例,T3N0M19例.采用超声引导下125I前列腺放射粒子植入术治疗.术后进行雄激素全阻断辅助治疗.观察术后并发症和临床疗效. 结果 手术时间1～2 h,4～6 d拔除尿管出院.术后随访6～53个月,平均17个月.CR 52例,PR 12例,SD 6例,PD2例.本组病例PSA无进展生存率为97.2%(70/72).Ⅰ级排尿症状47例,Ⅱ级排尿症状25例,无Ⅲ级和Ⅳ级排尿症状发生.伴有直肠刺激症状21例,多为轻度.术后严重出血性直肠炎1例,尿道直肠瘘1例,为同一患者,行结肠造口术和膀胱造瘘术.死亡1例. 结论 125I前列腺放射粒子植入术治疗前列腺癌疗效肯定、创伤小,尤其适合于不能耐受前列腺癌根治术的高龄前列腺癌患者.副作用主要为尿路和直肠症状,多为轻度和自限性的.     

前列腺癌根治术前的新辅助治疗

目的：评价前列腺癌根治性前列腺切除术前内分泌治疗的作用。方法：患者术前接受3个月(仅1例为6个月)的雄激素最大限度阻断治疗(LHRH类似物加非甾体抗雄激素药物)。结果：31例患者平均随访40．3个月(18～72个月)、治疗后PSA均下降，28例(90．3％)降至0．5ng／ml以下，3例(9．7％)未降至0．5ng／ml，其中2例术后PSA升高和局部复发。治疗后临床分期与治疗前相比降低4例(12．9％)，升高5例(16．1％)。前列腺切缘肿瘤阳性2例(6．5％)。8例(25．8％)术后20．4个月(6～50个月)出现PSA升高，其中6例(19.4％)术后33.2个月(13～59个月)肿瘤复发，1例死亡。结论：经新辅助内分泌治疗，临床分期和前列腺切缘肿瘤的阳性率降低。     

89例中晚期前列腺癌内分泌治疗临床分析

目的探讨内分泌治疗中晚期前列腺癌的临床疗效以及前列腺特异性抗原（PSA）在临床诊疗中的价值。方法对内分泌治疗的中晚期前列腺癌患者进行随访,并结合临床资料进行分析。结果共随访89例中晚期前列腺癌患者,其中死亡20例,获取完整随访资料者72例,97%患者临床症状得到改善,血清PSA下降[治疗前（106.32±197.66）ng/ml与治疗后3个月（22.35±126.32）ng/ml（t=3.67,P〈0.01）;治疗前与治疗后6个月（36.29±173.00）ng/ml（t=3.50,P〈0.01）;治疗后3个月与治疗后6个月（t=-0.782,P〉0.05）]。结论内分泌治疗可明显控制前列腺癌疾病进展,改善尿路梗阻等症状;PSA在前列腺癌的早期诊断、临床分期、疗效监测及预后判定中可发挥重要作用,对于伴有下尿路梗阻的患者,是否结合经尿道前列腺电切术（TURP）进行治疗,仍然需要进一步探讨。     

膀胱内翻性乳头状瘤的诊断与治疗（附12例报告）

目的提高膀胱内翻性乳头状瘤（inverted papilloma of the bladder,IPB）的诊治水平。方法回顾性分析我院12例膀胱内翻性乳头状瘤患者的临床资料,结合文献资料进行探讨。结果 12例患者接受经尿道膀胱肿瘤电切术（TURBt）治疗,患者术后均恢复良好,无严重并发症。4例伴有前列腺增生者,同时行TURP术,术后排尿良好。术后病理明确诊断为膀胱内翻性乳头状瘤,其中小梁型9例、腺体型3例。4例同时行TURP者,术后前列腺组织病理为良性前列腺增生。术后均给予膀胱灌注化疗。术后随访6月-8年,未见肿瘤复发及恶性变。结论 IPB多见于男性,膀胱颈部和三角区多发,呈良性肿瘤特点生长,预后良好。诊断依赖于膀胱镜检查及术后病理检查。TURBt是IPB的标准治疗方法 ,术后给予膀胱灌注化疗有利于预防复发。     

以尿潴留为首发表现的前列腺癌临床分析（附43例）

目的:回顾分析以尿潴留为首发表现的前列腺癌患者的临床特点。方法:收集我院2001年7月至2014年7月以尿潴留为首发症状的前列腺癌患者43例,均经前列腺穿刺活检确诊。3例患者接受腹腔镜下腹膜外前列腺癌根治术,其余40例患者均接受经尿道前列腺电切术（transurethral resection of prostate,TURP）联合内分泌治疗［（最大限度雄激素阻断（maximal androgen blockade,MAB）］。统计其年龄分布、前列腺特异性抗原（prostate specific antigen,PSA）、直肠指检(digital rectal examination,DRE)阳性率、经直肠前列腺穿刺阳性针数、Gleason评分、骨转移、肿瘤分期、治疗后排尿恢复情况、IPSS评分及1年、3年、5年生存率。结果:43例患者的年龄中位数为69岁;直肠指检阳性率达81.4%（35/43）;PSA＞20 ng/ml者占62.8%（27/43）;经直肠前列腺穿刺（12+X针穿刺法）超过7针以上阳性的占76.7%（33/43）;Gleason评分≥7分占95.3%（41/43）;骨转移患者占76.7%（33/43）;临床分期T3b-T4期占88.4%（38/43）;治疗后6个月全部患者恢复了自主排尿,1年生存率为97.7%,3年生存率为79.1%,5年生存率为55.8%。结论:老年男性发生尿潴留应当考虑有前列腺癌的可能性,该类前列腺癌患者病程往往多为晚期且为高危患者,肿瘤压迫侵犯尿道及膀胱颈是排尿困难的主要原因,经尿道前列腺电切术联合内分泌治疗,可有效解除下尿路梗阻,控制肿瘤进展,提高患者生活质量。     

A predictive role of neoangiogenesis and comparison with other prognostic factors

Incidental prostatic carcinoma (ICP) has good prognosis related to low stage at diagnosis. Few rogressive cases demanding aggressive treatment need early identification. Neoangiogenesis proved its predictive role in prostatic carcinoma after radical prostatectomy. To reveal its value in ICP authors investigated specimens after transurethral resection of prostate (TURP). Retrospective study was performed on 68 ICP diagnosed in years 1985 1989. Microvessels highlighted by factor VIII were counted in a x200 microscope field (0,8012 mm 2 ) in most active areas of neovascularisation. Microvessel count was correlated with tumor differentiation degree, Gleason score, disease stage, and patients survival in at least 9 years after diagnosis. Higher maximal microvessel counts were associated with lower degree of tumor differentiation (p=0,005), Gleason score (p=0,001), and disease stage (0,003). No association with disease progression and patients survival was found. Mean microvessel counts showed less significant values when correlated with tumor differentiation degree (p=0,003) and Gleason score (p=0, 01), and no correlation with other variables. Microvessel density in TURP specimens of ICP retains its prognostic value already demonstrated in carcinoma of peripheral prostatic lobes. Maximal microvessel counts were prognostically more reliable than mean values.     

The association of treatment-related symptoms with quality-of-life outcomes for localized prostate carcinoma patients

BACKGROUND: Most studies of treatment outcomes in men with localized prostate carcinoma have emphasized sexual, urinary, and bowel symptoms with the assumption that they have an impact on quality of life. However, very few studies have directly examined and compared the impact of these symptoms on overall and cancer specific quality of life. METHODS: The authors examined 783 incident cases of localized prostate carcinoma, diagnosed from 1993 to 1998, and 1928 age-matched healthy controls from the Health Professionals Follow-Up Study cohort. Information on frequency of ejaculation and urinary symptoms were collected before cancer diagnosis. After cancer diagnosis, the authors mailed a questionnaire including the Medical Outcomes Study Short Form-36 Health Status Survey (SF-36), the Cancer Rehabilitation Evaluation System-Short Form (CARES-SF), and the University of California at Los Angeles Prostate Cancer Index in 1998. RESULTS: Cases had slightly lower scores on most of the SF-36 scales and reported much more bother from sexual, urinary, and bowel symptoms compared with healthy controls. Among prostate carcinoma patients, bowel symptoms had the greatest negative impact on quality of life, followed by sexual and urinary symptoms. As expected, treatment-related symptoms were associated with the physical domains of quality of life, but psychosocial domains were just as strongly affected. CONCLUSIONS: Patients and health care providers need to consider the potential mental quality-of-life impacts associated with prostate carcinoma treatment symptoms when making treatment decisions. Even after patients have completed cancer treatment, significant health impairments may remain. Health care providers should continue to address the mental and physical well-being of prostate carcinoma patients in follow-up care.     

Urinary Incontinence in Patients Who Have a TURP/TUIP Following Prostate Brachytherapy

Purpose: To determine urinary morbidity in patients who have transurethral resection of the prostate (TURP) after ¹²⁵I brachytherapy.Materials and Methods: A total of 109 patients with Stage T1–T2 prostatic carcinoma were treated with ¹²⁵I implantation from 1991 through 1995. Ten patients underwent TURP/transurethral incision of the prostate (TUIP) after brachytherapy to relieve urinary obstruction refractory to nonsurgical management.Results: Patients who developed refractory urinary retention had a slightly larger preimplant prostate volume than those who did not (62 vs. 54 ml; p = 0.16). Seven of the 10 patients developed some degree of permanent urinary incontinence following TURP/TUIP. Urinary incontinence was mild in three patients [Late Effects Normal Tissue Radiation Oncology Group (LENT) score = 1] and severe in four additional patients (LENT score = 3). There was no obvious relationship between the degree of incontinence and use of TURP vs. TUIP, amount of tissue resected, or time between brachytherapy and TURP/TUIP. In five patients for whom detailed urethral radiation dose information was available, the doses were higher than generally recommended.Conclusion: Permanent urinary incontinence is common in patients who require a TURP or TUIP after prostate brachytherapy. Its cause is apparently multifactorial and may include the degree of physical damage to the urinary sphincters and the radiation dose to the urethral region.     

Incidentally Detected Adenocarcinoma Prostate in Transurethral Resection of Prostate Specimens: a Hospital Based Study from India

Background: Awareness about prostate cancer has increased in the community, and prostate cancer screening examinations, including prostate specific antigen (PSA) assays, are now widely available. Prior to the PSA era, up to 27% of prostate cancers were detected incidentally at the time of transurethral resection of prostate (TURP). After PSA testing became widely available, the incidence of incidentally detected carcinoma prostate in TURP specimens without prior diagnosis reduced to 5-13%. However, the incidence of incidentally detected carcinoma prostate has been reported to vary across the globe since various factors can influence the identification of this malignancy in TURP specimens. In this paper, we focus on rates of incidentally detected prostate cancer in TURP specimens in our hospital and correlate it with various parameters. Materials and Methods: This retrospective study of histopathological findings of biopsy specimens was conducted for patients undergoing TURP during a period of 5 years from April 2010. The inclusion criteria were patients diagnosed with benign prostatic hyperplasia (BPH) (digital rectal examination (DRE) not showing any abnormally hard areas and normal age adjusted PSA values). Patients with elevated PSA, abnormal DRE, documented urinary tract infection and proved adenocarcinoma prostate (CaP) were excluded from the study. The total weight of prostatectomy specimen, occurrence of carcinoma prostate in the chips, percentage of total tissue resected showing malignancy and Gleason's scores were recorded. Results: A total of 597 patients belonging to the inclusion criteria were studied. The incidence of occult CaP in the study group was 5.2 % (31/597). Out of these, 8 belonged to T1a and 23 belonged to T1b stages. The age group 70 - 79 years had the maximum incidence of occult CaP. It was observed that the clinical grading of prostate did not have a bearing on the incidence of occult CaP whereas the weight of resected specimen correlated with the incidence of CaP. The incidence of occult CaP was greater with low volume prostates ( < 20 g). (P=0.15). Conclusions: The rate of incidentally detected adenocarcinoma prostate in patients undergoing TURP for clinically diagnosed BPH was found to be only 5.2 % in our study which is low when compared with similar studies done elsewhere. The age of the patient and weight of the resected specimen correlated with incidence of occult prostate cancer. The clinical grading of prostate by DRE however, demonstrated no correlation.     

Urinary morbidity following ultrasound-guided transperineal prostate seed implantation.

PURPOSE: To assess the urinary morbidity experienced by patients undergoing ultrasound-guided, permanent transperineal seed implantation for adenocarcinoma of the prostate. METHODS AND MATERIALS: Between September 1992 and September 1997, 693 consecutive patients presented with a diagnosis of clinically localized adenocarcinoma of the prostate, and were treated with ultrasound-guided transperineal interstitial permanent brachytherapy (TPIPB). Ninety-three patients are excluded from this review, having received neoadjuvant antiandrogen therapy. TPIPB was performed with 125I in 165 patients and with 103Pd in 435 patients. Patients treated with implant alone received 160 Gy with 125I (pre TG43) or 120 Gy with 103Pd. One hundred two patients received preimplant, pelvic external beam radiation (XRT) to a dose of either 41.4 or 45 Gy because of high-risk features including PSA > or = 10 and/or Gleason score > or = 7. Combined modality patients received 120 Gy and 90 Gy, respectively for 125I or 103Pd. All patients underwent postimplant cystoscopy and placement of an indwelling Foley catheter for 24-48 h. Follow-up was at 5 weeks after implant, every 3 months for the first 2 years, and then every 6 months for subsequent years. Patients completed AUA urinary symptom scoring questionnaires at initial consultation and at each follow-up visit. Urinary toxicity was classified by the RTOG toxicity scale with the following adaptations; grade 1 urinary toxicity was symptomatic nocturia or frequency requiring none or minimal medical intervention such as phenazopyridine; grade 2 urinary toxicity was early obstructive symptomatology requiring alpha-blocker therapy; and grade 3 toxicity was considered that requiring indwelling catheters or posttreatment transurethral resection of the prostate for symptom relief. Log-rank analysis and Chi-square testing was performed to assess AUA score, prostate size, isotope selection, and the addition of XRT as possible prognosticators of postimplant urinary toxicity. The prostate volume receiving 150% of the prescribed dose (V150) was studied in patients to assess its correlation with urinary toxicity. RESULTS: Median follow-up was 37 months (range 6-68). Within the first 60 days, 37.3% of the patients reported grade 1 urinary toxicity, 41% had grade 2, and 2.2% had grade 3 urinary toxicity. By 6 months, 21.4% still reported grade 1 urinary toxicity, whereas 12.8% and 3% complained of grade 2 and 3 urinary difficulties, respectively. Patients with a preimplant AUA score < or = 7 had significantly less grade II toxicity at 60 days compared to those with an AUA score of >7 (32% vs. 59.2%, respectively, p = 0.001). Similarly, prostatic volumes < or = 35 cc had a significantly lower incidence of grade II urinary toxicity (p = 0.001). There was no difference in toxicity regarding the isotope used (p = 0.138 at 60 days, p = 0.45 at 6 months) or the addition of preimplant XRT (p = 0.069 at 60 days, p = 0.84 at 6 months). Twenty-eight patients (4.7%) underwent TURP after 3 isotope half-lives for protracted obstructive symptoms. Five of these men (17%) developed stress incontinence following TURP, but all patients experienced relief of their obstructive symptoms without morbidity at last follow-up. The percent of the prostate receiving 150% of the prescribed dose (V150) did not predict urinary toxicity. CONCLUSIONS: TPIPB is well tolerated but associated with mild to moderate urinary morbidity. Pretreatment prostatic volume and AUA scoring were shown to significantly predict for grade 2 toxicity while the use of preimplant, pelvic XRT and isotope selection did not. Patients undergoing TURP for protracted symptoms following TPIPB did well with a 17% risk of developing stress incontinence. V150 did not help identify patients at risk for urinary morbidity. As transperineal prostate implantation is used more frequently the associated toxicities and the definition of possible pretreatment prognostic factors is necessary to     

Effect of transurethral resection on urinary quality of life after permanent prostate brachytherapy

PURPOSE: To determine the effect of transurethral resection on urinary function after permanent prostate brachytherapy using a validated, patient-administered, quality-of-life (QOL) instrument. METHODS AND MATERIALS: Twenty-seven consecutive brachytherapy patients with clinical T1b-T2b (1997 American Joint Commission on Cancer) prostate cancer and a history of either preimplant or postimplant transurethral resection of the prostate (TURP) were evaluated. Of the 27 patients, 1 continued to be catheter dependent and was excluded from analysis. Of the remaining 26 patients, each was mailed the urinary function component of the Expanded Prostate Cancer Index (EPIC) and the International Prostate Symptom Score (IPSS). Twenty-six surveys (100%) were returned. The mean and median follow-up was 44.8 and 39.8 months, respectively. The clinical, treatment, and dosimetric parameters evaluated included age, pretreatment prostate-specific antigen level, Gleason score, stage, risk group, prostate volume, presence of diabetes and hypertension, tobacco consumption, number of TURPs, number of grams resected, ultrasound planning volume, hormonal status, supplemental external beam radiotherapy, isotope, follow-up (in months), minimal dose received by 90% of the prostate gland, percentage of prostate volume receiving 100%, 150%, and 200% of the prescribed minimal peripheral dose, and the average and maximal urethral dose. Because baseline IPSSs, but not EPIC scores, were available, a cross-sectional survey was performed in which 51 newly diagnosed prostate cancer patients yet to receive any therapeutic intervention and 195 non-TURP brachytherapy patients served as controls. RESULTS: For all evaluated parameters, superior urinary scores were noted in the preimplant TURP group, with intermediate scores in the postimplant TURP patients and poor urinary QOL scores in the pre- and postimplant TURP patients. With time, the EPIC scores improved in the pre- and postimplant TURP cohorts. In multivariate linear regression analysis of the EPIC urinary summary score, the number of TURPs and supplemental external beam radiotherapy were the strongest predictors for diminished QOL. CONCLUSION: TURP results in diminished urinary QOL after brachytherapy. However, patients who underwent preimplant TURP had urinary QOL approaching that of non-TURP brachytherapy patients. Significant urinary dysfunction was noted in approximately one-half of patients who underwent postimplant TURP (especially pre- and postimplant TURP). Because most patients with brachytherapy-related urinary obstruction will eventually spontaneously void, TURP should be approached with extreme caution and only after substantial time has transpired.     

Long-term urinary toxicity after 3-dimensional conformal radiotherapy for prostate cancer in patients with prior history of transurethral resection

PURPOSE: To report on the long-term urinary morbidity among prostate cancer patients with a prior history of a transurethral resection of the prostate (TURP) treated with high-dose 3-dimensional conformal radiotherapy (3D-CRT). METHODS AND MATERIALS: Between 1988 and 1997, 1100 patients with clinically localized prostate cancer were treated with 3D-CRT. Of these, 120 patients (8%) were identified as having had a prior TURP and are the subjects of this analysis. The median age was 71 years (range: 49-83 years). The clinical stages of the patients were T1c: 33 (28%); T2a: 38 (32%); T2b: 15 (13%); and T3: 34 (27%). Neoadjuvant androgen ablation therapy was given to 39 (33%). The median radiation dose prescribed to the planning target volume was 75.6 Gy (range: 64.8-81 Gy). The median elapsed time from TURP to initiation of 3D-CRT was 69 months (range: 4-360 months). The median follow-up time was 51 months (range: 18-109 months). RESULTS: Five patients of the 120 with a prior history of TURP (4%) developed a urethral stricture after 3D-CRT which was corrected with dilatation. The 5-year actuarial likelihood of >/= Grade 2 late urinary toxicities was 9%. No Grade 4 urinary toxicities were observed in this group of patients. Among 110 patients who were completely continent of urine prior to 3D-CRT, 10 (9%) developed stress incontinence requiring 1 pad daily for protection or experienced occasional leakage (not requiring pad protection). The 5-year incidence of >/= Grade 1 stress incontinence was 18% in patients who developed acute >/= Grade 2 GU symptoms during the course of 3D-CRT compared to 7% for patients who experienced Grade 1 or no acute urinary symptoms (p = 0.05). The radiation dose (>/=75.6 Gy vs. <75.6 Gy), the number of prior TURP procedures, or the volume of resected tissue at the time of TURP had no significant impact on the long-term urinary morbidity outcome. A multivariate analysis demonstrated that the presence of Grade 2 acute urinary symptoms was the only predictor of >/= Grade 1 stress incontinence after 3D-CRT in this group of patients. CONCLUSIONS: Despite prior TURP, the incidence of >/= Grade 3 urinary toxicities is low. Nevertheless, especially among patients with a prior history of TURP who experience Grade 2 acute urinary symptoms during radiation treatment, a higher risk of stress incontinence is observed.