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

Pinkawa, Michael; Klotz, Jens; Djukic, Victoria; Petz, Dalma; Holý, Richard; Eble, Michael J.

doi:10.1111/iju.12460

Cited by 6 publications

(3 citation statements)

References 29 publications

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“…Several studies have proposed that TURP was a predictor of decline in urinary QOL and GU morbidity in photon external radiotherapy [27–29]. This suggestion is based on the fact that TURP induces long-term structural damage to the urethra in the prostate, and photon radiation might have additive effects on the lesions [28, 30].…”

Section: Discussionmentioning

confidence: 99%

Preliminary exploration of clinical factors affecting acute toxicity and quality of life after carbon ion therapy for prostate cancer

Zhang

Li²,

et al. 2019

Radiat Oncol

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Purpose To assess toxicity and quality-of-life (QOL) after carbon ion radiotherapy (CIRT) at the Shanghai Proton and Heavy Ion Center (SPHIC) and identify clinical factors that correlate with urinary, bowel and sexual function. Methods Sixty-four patients with localized prostate cancer admitted from July 2015 to January 2018 underwent CIRT. At baseline and 5 time-points after radiotherapy, we assessed patients’ QOL using the 26-item edition of the Expanded Prostate Cancer Index-Composite (EPIC-26) Chinese version. Logistic regression was performed to identify clinical factors associated with acute genitourinary (GU) toxicity and relative QOL. Results By the end of CIRT, urinary irritation/obstruction temporarily declined (− 7.92 ± 1.76, p < .001). For urinary incontinence, bowel and sexual QOL, the scores remained stable at 2-year follow-up. The occurrences of acute Grade 1 and 2 GU toxicity were 20.3 and 10.9%, respectively, and of late Grade 1 and 2 GU toxicity were 3.1 and 1.6%, respectively. No acute or late gastrointestinal (GI) toxicity occurred. Transurethral resection of the prostate (TURP) was a risk factor that predicted a decline in urinary related QOL, and age made a difference to bowel-related QOL. For sexual QOL, castration status was a remarkable risk factor. An international prostate symptom score (IPSS) ≥8 increased the risk of Grade 1–2 acute GU toxicity 5.3-fold. Conclusion Patients with prostate cancer had favorable QOL after CIRT. IPSS ≥8 was a risk factor to acute GU toxicity, and TURP predicted a decline in urinary QOL. Age was related to bowel QOL, and castration status was associated with sexual QOL. Trial registration Carbon Ion Radiotherapy for the Treatment of Localized Prostate Cancer, NCT02739659 . Registered April 15, 2016.

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Section: Discussionmentioning

confidence: 99%

Preliminary exploration of clinical factors affecting acute toxicity and quality of life after carbon ion therapy for prostate cancer

Zhang

Li²,

et al. 2019

Radiat Oncol

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“…Pinkawa et al, in a matched pair analysis, showed that patients undergoing TURP after EBRT have better urinary function score compared to patients who underwent EBRT alone. 2 On the other hand, Liu showed that these patients have a five-fold risk of incontinence compared to non-operated patients (5-year rate of 8% vs 1.5%, p=0.0015). 3 A rate of 27% new-onset incontinence was reported in another series.…”

Section: Introductionmentioning

confidence: 96%

Transurethral Prostatectomy Before or After External Beam Radiotherapy: Complications and Reoperation Rates

Molineros¹,

Meirovitz²,

Wygoda³

et al. 2021

RRU

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Purpose: Patients treated by external beam radiotherapy (EBRT) for localized carcinoma of the prostate (CAP) often suffer from urinary obstruction. While most patients can be treated medically, some require transurethral prostatectomy (TURP) for alleviation of obstruction. The consequences of combing EBRT and TURP are controversial. The objective of this study was to evaluate the success and complication rates of TURP combined with EBRT. Patients and Methods: Between 2001 and 2017, 3501 patients underwent TURP. Sixty-six of them were treated with EBRT for CAP. Surgical complications according to the Clavien-Dindo (CD) scale and the need for secondary interventions were compared to 66 randomly selected patients operated on for benign prostatic hyperplasia (BPH). Results: Patients who underwent TURP for BPH were significantly older compared to the patients with CAP with an average of 76.4 (SD 4.3) vs 71 (SD 8.2) years, p<0.0001. Substantial post-operative complications were rare in both groups with only a single case of CD grade 3 in each group. However, patients with CAP required significantly more secondary surgeries (21% vs 6%, p=0.02) and significantly more additional interventions (37.9% vs 13.6%, p=0.0025). There was no difference in complication rate, in the need for additional interventions or in the oncological outcome when comparing patients operated before or after EBRT. Conclusion:The complication rate of TURP done before or after EBRT is low and comparable to surgery for BPH. However, the rates of secondary surgeries and additional interventions in these patients are high (40%). TURP before or after EBRT provides similar results.

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“…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” . 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.…”

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confidence: 99%

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

Sio

2014

Int J of Urology

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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...

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

Cited by 6 publications

References 29 publications

Preliminary exploration of clinical factors affecting acute toxicity and quality of life after carbon ion therapy for prostate cancer

Preliminary exploration of clinical factors affecting acute toxicity and quality of life after carbon ion therapy for prostate cancer

Transurethral Prostatectomy Before or After External Beam Radiotherapy: Complications and Reoperation Rates

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

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