Brachytherapy After TURP
Dear OncoLink "Ask The Experts,"
I was told seed implants were not an option after TURP. Is this true?
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.
Prostate gland before and after a TURP procedure: