Re: Iodine-125 Seed Implantation and Deferred Transurethral Resection of the Prostate for Patients With Lower Urinary Tract Symptoms and Localized Prostate Cancer

Dear Sir, Several recent studies have challenged the view that patients with localized prostate cancer (PCa) and lower urinary tract symptoms (LUTS) are poor candidates for prostate brachytherapy because of the risk of postoperative urinary morbidity. Liu et al reported their experience in which 38 men with localized PCa and preexisting LUTS underwent iodine-125 seed implantation followed by delayed (6 months) limited transurethral resection of the prostate (LTURP). They report statistically significant reductions in mean International Prostate Symptom Score (IPSS) at 5 to 7 days and 1 year after LTURP, and no patients with persistent retention, urinary incontinence, or urethral necrosis. Unfortunately, this approach requires that men endure moderate to severe (mean IPSS of 15.42) LUTS, and for some, daily catheterizations for persistent retention, for 6 months before receiving effective surgical therapy. Our approach, published in Brachytherapy in 2012, is to perform LTURP and/or transurethral incision of the prostate (TUIP) 4 to 7 months before planned brachytherapy in men with LUTS and localized PCa. We reported similar significant reductions in IPSS, peak flow rate, and post-void residual, and no patients developed persistent retention, urinary necrosis, or urinary incontinence. Most importantly, our two-step approach provided timely relief of symptoms for our patients without comprising the management of their PCa. Liu et al suggest that our approach might lead to unnecessary surgery in patients who are “high-risk” for obstruction but might not necessarily need a transurethral resection of the prostate, thus resulting in potentially avoidable complications. First, we used