Login to Access Video or Poster Abstract: MP05-11
Sources of Funding: None

Introduction

Numerous studies have examined urinary symptoms and incontinence risk in brachytherapy (BT) patients undergoing transurethral resection of the prostate (TURP), but there are limited data on quality of life (QOL) outcomes in this population. We aimed to evaluate the long-term impact of TURP and BT on QOL, in particular, as a function of pre-treatment symptom severity and timing of TURP in relation to implantation.

Methods

1848 patients underwent BT with or without external beam radiation therapy (EBRT) for the diagnosis of prostate cancer between October 1990 and May 2011 and were followed a minimum of 5 years. In total, 160 (8.7%) patients underwent TURP before or after implant for refractory urinary symptoms or retention. International Prostate Symptom Scores (I-PSS) and QOL bother scores were recorded prior to implantation and at follow-up evaluations. Patients were subdivided by timing of TURP - pre-implant (n=85), post-implant (n=69), pre- and post-implant (n=6) - and compared to patients not receiving TURP (n=1688). Paired t-test was used to analyze changes in QOL, stratified by pretreatment I-PSS. Chi-squared test and multivariate logistic regression were used to assess clinical and treatment-related factors predictive of worse long-term QOL.

Results

Median follow up after implantation was 9.0 years and median time to post-implant TURP was 20.0 months. Across all groups, men with mild pretreatment I-PSS had worsening urinary QOL (p<.001), while those with severe pretreatment I-PSS improved (p=.005). This was also true for men who never had a TURP (p<.001 for mild, p<.001 for severe). Men with moderate symptoms undergoing TURP had no significant QOL change (p=.89). In men with pretreatment QOL score < 2, age over 65 years was the only predictor of poor QOL (score ≥ 3) at last follow up; EBRT, hormone therapy, and BED > 200 Gy had no influence on reported QOL in these men.

Conclusions

Most BT patients regressed toward the mean over time with respect to urinary QOL, irrespective of receipt or timing of TURP. Men with worse urinary QOL who underwent a post-implant TURP improved while men with a mild QOL bother score were worse after TURP. These data suggest a more conservative approach should be considered when electing a post-implant TURP unless patients have significant bother.

Funding

None