Iodine-125 seed implantation and deferred transurethral resection of the prostate for patients with lower urinary tract symptoms and localized prostate cancer.

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 (125)I 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.