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Complications after Brachytherapy - TURP?

Thanks so much for your positive outlook. After doing some research, I too disagree slightly with Terry. They say it's safe from 6 months after brachytherapy. Unfortunately, I don't think any of the doctors have offered this as treatment, or have even mentioned the procedure. He is going in on Tuesday to have his catheter removed, once again, so we'll certainly know within hours if it will work this time around. It the removal is unsuccessful, I'm certainly going to find other alternatives as he can't live the remainder of his life this way - trapped in his own house unable to enjoy the rest of his years.

Thanks again for your point of view, it's nice to hear some success stories.

Re: Complications after Brachytherapy - TURP?

Tammy,

I did a little research on this and wanted to share what I found with you. Like always with this disease I advise caution and consulting with more than one medical advisor. Here's a link and quote from one of the articles I found. I looked at several but wanted you to see at least some of the information I found.

Urinary incontinence in patients who have a TURP/TUIP following prostate brachytherapy

Here's the abstract from the article.

Purpose: To determine urinary morbidity in patients who have transurethral resection of the prostate (TURP) after{sup 125}I brachytherapy. Materials and Methods: A total of 109 patients with Stage T1-T2 prostatic carcinoma were treated with{sup 125}I implantation from 1991 through 1995. Ten patients underwent TURP/transurethral incision of the prostate (TUIP) after brachytherapy to relieve urinary obstruction refractory to nonsurgical management. Results: Patients who developed refractory urinary retention had a slightly larger preimplant prostate volume than those who did not (62 vs. 54 ml; p= 0.16). Seven of the 10 patients developed some degree of permanent urinary incontinence following TURP/TUIP. Urinary incontinence was mild in three patients[Late Effects Normal Tissue Radiation Oncology Group (LENT) score= 1] and severe in four additional patients (LENT score= 3). There was no obvious relationship between the degree of incontinence and use of TURP vs. TUIP, amount of tissue resected, or time between brachytherapy and TURP/TUIP. In five patients for whom detailed urethral radiation dose information was available, the doses were higher than generally recommended. Conclusion: Permanent urinary incontinence is common in patients who require a TURP or TUIP after prostate brachytherapy. Its cause is apparently multifactorial and may include the degree of physical damage to the urinary sphincters and the radiation dose to the urethral region.

My only reason to post this is to advise caution and consults with more than one physician before going for a TURP.

The Stranger

Re: Re: Complications after Brachytherapy - TURP?

Stranger,
I think it somewhat unwise to make sweeping generalizations from such a limited (10 men only), and outdated (1995 and earlier) study. Do you have some more current information, which you may care to share with fellow forum members.
John

Re: Re: Re: Complications after Brachytherapy - TURP?

John,

I'm sorry you took exception to my post.

I tried to make sure in my opening and closing comments to point out my intention was to recommend caution and to seek more than one medical advisors guidance before moving forward with a TURP.

I seen more than one article that mentioned the possible dangers and maybe all of them were old and recent advances have greatly improved a TURP after Brachytherapy. I don't always look at the dates of the articles but glean as much information from them as possible. But I assure you my only intention was to present the information I found and recommend proceeding with caution.

Of course the article spoke stronger but they were not my comments so I hope you can separate my comments from the Doctor's comments. The intention of my post was to advise caution and to move forward slowly not seeking a quick fix. If my post did not convey that message I apologize for that.

You ask for other information.

Potential brachytherapy complications

Quote from article

Severe or Potentially Severe

Incontinence of urination - Some patients have had temporary urgency incontinence after the brachytherapy procedure (meaning if they get the call they must void immediately or they will wet themselves). This condition normally improves to complete resolution over time. Rare patients will have permanent incontinence – most likely to occur if a trans-urethral resection of prostate (known as a “TURP”) occurs after the brachytherapy procedure. In our experience, patients who have had a TURP procedure prior to the brachytherapy procedure have normally done well from a urologic viewpoint, as long as a peripheral loaded brachytherapy technique was done.

I would also like to point out that information from the past is not necessarily discountable, case in point, some posters on this forum are having what I call serious issues after radiation therapy that most often doesn't happen these days, but it did for them so the danger is there. Articles from the past often point out things newer articles do not, so pointing out what happened in the past and advising caution and multiple consults seems appropriate to me and I'm sorry if you disagree.

In closing I'll restate something I said from a post to Joe 67, one person dies at 36 from lung cancer and another dies at 96 from something else although both were heavy smokers. The point being, each person is different and what helps and harms them often makes no sense.

By the way, the person that died at 36 of lung cancer in my comment above was my sister. Another sister died at 45 from lung cancer. My father died at 62 from lung cancer. So advising caution for any treatment is my first thought and my concern for Tammy's father is his quality of life. I pray to God that if he needs a TURP his quality of life improves, he deserves the best life possible and if a TURP will give that to him I'm all for it. But make sure and do everything possible before the surgery by consulting at least two doctors.

I'm sorry to go on like this and share my family history but I'm a person with great empathy and my heart was breaking for Tammy's father and I wanted to make sure they didn't move forward before they were sure it was the right thing to do.

Tammy, if you're reading this please tell your Father I prayed for him and hope when the catheter is removed everything is fine, and if he needs a TURP everything goes perfectly and he recovers fully. Medical articles are very generic and DO NOT represent what will happen to everyone so use them as a guide to what questions to ask your physician so you have the information needed to do the right thing.

The Stranger

Complications after Brachytherapy - TURP?

I want to thank all that posted replies to my questions. Any and all information is great. I am one to do loads of research myself, but it is always nice to get others opinions that may have personal experience with the subject. Stranger, I greatly appreciate you praying for him. John, I value your positive outlook on things.

Tuesday will be the real test, when they take the catheter out, once again. Hopefully all will go well and all of this will have been just been time spent talking to kind strangers. If not, at least I am armed with some great information, choices, facts and opinions.

I will let you know how things went after the removal.

Thanks again, for taking the time to help.

Update

Well, things didn't turn out as we had hoped... My Dad went to the Urologist yesterday afternoon and was told he should remove it himself this morning. He did so at 9:30am. At 1:00pm my sister called to see how things were going and he said he had to go every 15 min, but wasn't in any pain. He said he felt he was releived after. At 3:30pm I got a call that they were heading to the hospital to have the catheter put back in. I'm still not completely sure why. He said he wasn't in any pain, but I guess when they contact the Urologist he said he should be urinating more than he was and that he should immediately go to the hospital and have it put back in. At the hospital they thought he may have an infection and the Doctor there said he may need it for the rest of his life - he also asked if the cancer had spread... not sure why he asked, but we would have no way of knowing.

My Dad had the brachytherapy almost one year ago to the day, but they have never done any further testing (ultrasound, laparoscopy) besides testing his PSA levels to see if there is any spread of cancer or any other cancer that may be in the area (ie: colon cancer or ??) Is this normal? He complains often that he doesn't have a proper bowel movement and the doctors just suggest fibre supplements or the last one was a herbal remedy the doctor suggested.

The worst part is that my Dad doesn't communicate anything to us and gets angry at us if we suggest something or make comments as to what should be done. He takes the Doctors word like it is the "spoken word". He would never question what they say, or ask why and he always downplays his symptoms when they ask him questions - never complains.

He is supposed to call his Urologist in the morning and his GP. I'm going to demand that I attend his appointments and get to the bottom of this. Something just doesn't sit right with me and I need to have some answers as to what is happening... wish me luck!!

No News

Here's an update... No News! I insisted on going to the doctor appointment with my Mom & Dad, both insisted I didn't need to. The urologist said to wait, the oncologist said he'd consult the doctor that put the implants in and get her opinion and the 3 of them would have a "chat" to see what the problem may be, or if there is a solution. So in otherwords, nothing is happening. I told my parents it would take at least a couple of months to get any answer from 3 doctors. My Dad doesn't seem too concerned. They treated him for a UTI and he seems to have felt better, more energy and happier, but he still has difficulty sitting for any length of time - apparently this is due to the catheter.

At this point there is nothing I can do. You can only help someone if they want the help. Both of my parents tend to accept things as they come, and neither one of them have any fight in them. They accept their ailments and feel there is nothing they can do to better themselves or their illnesses.

I will post any significant updates as they come, but I don't expect to get any great news for some time.

Hope you all had a wonderful Christmas, and all the best of 2009 to you.

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