Aims

Although the results on acute and late toxicity of ultrahypofractionation are encouraging, data on safety in prostate cancer patients with a medical history of transurethral resection of the prostate (TURP) or adenomectomy remain scarce, especially in cases of repeated procedures. The aim of the present study was to report on long-term toxicities after stereotactic body radiotherapy (SBRT) of prostate cancer patients with previous surgical treatment of benign prostatic hyperplasia.

Materials and methods

Among 150 patients treated with SBRT (median dose 36.25 Gy in five fractions) realised from 2014 to 2019 in a single-centre institution, data of 24 men with a history of TURP (n = 19) or adenomectomy (n = 5) were analysed. Repeated TURP was carried out in three patients, with a median time between surgery and SBRT of 54 months. Genitourinary toxicity was assessed using the Common Terminology Criteria for Adverse Events v4.0 grading scale.

Results

With a median follow-up of 45 months, 10 of 24 (42%) patients experienced at least one episode of transient haematuria. One patient (4%) with three previous TURP presented a grade 3 acute non-infective cystitis. Late grade 2 and 3 genitourinary toxicities were observed in eight (33%) and four patients (17%) (two treated with adenomectomy, one with multiple TURP and one with a 140 cm³ prostate size), respectively, with no grade ≥4 adverse events. A complete recovery of grade 3 genitourinary toxicities was observed for all patients after hyperbaric oxygen therapy.

Conclusion

Prostate SBRT is feasible and well-tolerated in patients with a medical history of surgical treatments of benign hyperplasia. Patients with prior adenomectomy or multiple TURP are at higher risk of developing severe genitourinary toxicity and should be carefully evaluated before SBRT treatments.

中文翻译：

---

良性前列腺增生和前列腺癌立体定向放射治疗的手术治疗：对长期泌尿生殖系统毒性的影响

目标

尽管超大分割的急性和晚期毒性结果令人鼓舞，但关于有经尿道前列腺切除术 (TURP) 或腺瘤切除术病史的前列腺癌患者的安全性数据仍然很少，特别是在重复手术的情况下。本研究的目的是报告既往接受过良性前列腺增生手术治疗的前列腺癌患者立体定向放射治疗 (SBRT) 后的长期毒性。

材料和方法

在单中心机构于 2014 年至 2019 年实现的 150 名接受 SBRT（五次中位剂量 36.25 Gy）治疗的患者中，分析了 24 名有 TURP（n = 19）或腺瘤切除术（n = 5）病史的男性的数据. 对三名患者进行了重复 TURP，手术和 SBRT 之间的中位时间为 54 个月。使用不良事件通用术语标准 v4.0 分级量表评估泌尿生殖系统毒性。

结果

中位随访时间为 45 个月，24 名患者中有 10 名 (42%) 经历了至少一次短暂性血尿。1 名患者 (4%) 曾接受过 3 次 TURP，出现 3 级急性非感染性膀胱炎。分别在 8 名 (33%) 和 4 名患者 (17%) 中观察到 2 级和 3 级晚期泌尿生殖系统毒性（两名接受腺瘤切除术治疗，一名接受多个 TURP 治疗，一名接受 140 cm ³前列腺大小），没有≥4级不良事件。在高压氧治疗后，观察到所有患者的 3 级泌尿生殖系统毒性完全恢复。

结论

前列腺 SBRT 在有良性增生手术治疗病史的患者中是可行的且耐受性良好。既往接受过腺瘤切除术或多次 TURP 的患者发生严重泌尿生殖系统毒性的风险较高，应在 SBRT 治疗前仔细评估。