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Brachytherapy After TURP

Brachytherapy After TURP

Question

Dear OncoLink "Ask The Experts,"

I was told seed implants were not an option after TURP. Is this true?

Answer

Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:

When brachytherapy (seed implant) is performed, the seeds are inserted throughout the prostate gland. After the urologist does a TURP, there is not enough of the central portion of the prostate gland left to hold the seeds.

The TURP may also affect the urinary sphincter, so there is a much higher risk of incontinence with a prostatectomy performed after TURP. For this reason, most men who are diagnosed by a TURP will get external beam radiation. In fact, most urologists do not do a TURP when they suspect prostate cancer, so that more options are available later for therapy. The reason for the problem is that the prostate has a central zone that gets larger as you get older, and a peripheral zone that is the most common part of the prostate for cancer to be located. It is kind of like an orange with a thick peel. The central pulpy part is what gets larger as you get older. The rind is where the tumors arise. A TURP takes out the orange pulp but does not want to mess with the rind, as that means they are getting closer to other tissues that may be injured -- so a TURP is not a cancer operation.

I should also say that this is a subjective assessment. Some urologist do what is called a "channel TURP", where they just remove the center of the gland, but most do a complete TURP so they don't have to go back and do another one in 2 or 3 years, which can lead to a higher complication rate. After a channel TURP, there may be enough central zone left to do an implant, although with the simultaneous scarring from the TURP and from the radiation, the complication rate is high. I have done a number of implants 5-10 years after TURP in cases where there has been some central regrowth. The acute irritation is worse, but the long-term effects on voiding and the rectum are not increased.

Prostate gland before and after a TURP procedure:

Prostate gland before and after a TURP procedure