Editorial Comment to Transurethral resection of the prostate after radiotherapy for prostate cancer: Impact on quality of life

Abstract

Prostate cancer is the most common form of non-cutaneous malignancy in North America, and the third by incidence worldwide in males. As surgical, radiotherapeutic and systemic therapies continue to improve, the chance of a cure, and consequently long-term survival, has increased in patients with prostate cancer. The 5-year disease-specific survival rate of patients diagnosed with prostate-confined cancer well exceeded 95%. Additionally, in the prostate-specific antigen screening era, more patients present with asymptomatic cancer and no genitourinary deficits at all. Consequently, maximizing and preserving the quality of life (QOL) in these patients after treatment has become important, as a significant portion of them will reach their expected life expectancy. The impact of a patient's prior genitourinary procedures, such as transurethral resection of the prostate (TURP) for benign prostatic hyperplasia, is a significant QOL contributor in this group of patients. Patients receiving prostatectomy or external beam radiotherapy (EBRT) might show different long-term QOL profiles.1 Historically, prior TURP is a relative contraindication for low-doserate brachytherapy (a permanent, radioactive seed implant technique), but not for radical prostatectomy. In prostate cancer patients with a history of prior TURP, newer evidence has suggested that the adverse event rates of high-dose-rate brachytherapy, a temporary implant with improved dosimetric flexibilities intraoperatively, are low and could be acceptable. However, the short-term and long-term QOL impacts of TURP on EBRT outcome in prostate cancer patients are largely unknown, because of a lack of prospective evaluation on this topic.In this issue of International Journal of Urology, Pinkawa et al. published a retrospective, matched-pairs study titled "Transurethral resection of the prostate after radiotherapy for prostate cancer: Impact on quality of life". 3 A group of 49 patients with prior TURP who successfully completed EBRT was retrospectively compared with 487 patients without TURP; they were all treated in the same era at the authors' institution in Germany. Their use of higher EBRT doses (70.2-80 Gy per course) was modern, with incorporation of 3-D conformal, intensity-modulated (IMRT) and image-guided radiation therapies in the majority of their patient cases. The use of androgen deprivation therapy was equal in both arms (35% each). In balancing the heterogenous factors in their population, the authors additionally carried out a one-to-one matching for their cohort of 49 patients with TURP. The QOL survey tool was given over multiple time-points including baseline. The authors reported significantly fewer short-term symptoms (lower drops in QOL compared with baseline, across multiple domains) in patients who had prior TURP compared with those without a TURP history. Their long-term outcome showed that QOL was acceptable in this group of patients with TURP, except for those patients who underwent the procedure more than 2.5 years before EBRT (poorer inconti...