Surgery OK after prostate "seed" treatment

If necessary, the prostate can be removed after six months of prostate cancer treatment with implanted radioactive seeds, or brachytherapy, a French group reports.

For men with prostate cancer, implantation of radioactive seeds in the prostate to kill cancerous cells has become a popular alternative to radical surgery or external radiation therapy. In some cases, though, the seeds cause bothersome problems with urination and prostate removal has to be considered.

The question has been, how soon can removal be performed without jeopardizing the eradication of cancer? Also, is it safe to use a less invasive procedure than radical surgery?

Dr. Thierry A. Flam of Hopital Cochin, Paris, and colleagues evaluated 600 patients who underwent brachytherapy without any other treatment at their institution between 1998 and 2003. Of these patients, 19 (3 percent) subsequently underwent transurethral resection of the prostate (TURP) - that is, removal of prostate tissue via the urinary outlet, which doesn't require surgical incisions

Urinary retention had developed in these patients an average of 2 months after brachytherapy, but TURP was not performed for at least 6 months after the implant and in some cases not until 41 months later.

No cases of incontinence resulted from the procedure, "and TURP allowed return to normal voiding patterns in all cases," the authors report in the Journal of Urology.

Moreover, the researchers found that none of the patients had any sign of cancer recurrence at an average of 28 months after brachytherapy.

Flam's team concludes that when TURP is performed at least 6 months after seed implantation it "can be done safely" without impairing the results of brachytherapy.

SOURCE: Journal of Urology, July 2004.