A. Henderson

125Iodine prostate brachytherapy: outcome from the first 100 consecutive patients and selection strategies incorporating urodynamics

Objective  To report the results from the first 100 consecutive patients treated with 125 I transperineal interstitial prostate brachytherapy between March 1999 and June 2001, and to determine if the International Prostate Symptom Score (IPSS), prostate volume or urodynamic variables correlate with acute morbidity.

Biochemical (prostate-specific antigen) relapse-free survival and toxicity after 125I low-dose-rate prostate brachytherapy

To report our clinical experience and 5‐year prostate‐specific antigen (PSA) relapse‐free survival rate for early‐stage prostate cancer after 125I low‐dose‐rate prostate brachytherapy.

A Spanner in the works: the use of a new temporary urethral stent to relieve bladder outflow obstruction after prostate brachytherapy.

PURPOSE Assessment of the Spanner, a new temporary urethral stent to relieve bladder outflow obstruction and urinary symptoms after brachytherapy. METHODS AND MATERIALS Five patients with unusually severe urinary morbidity after (125)I brachytherapy were recruited. The mean time after implant was 40 days (range 25-90). Spanner intraprostatic stents were introduced using topical anesthetic without complication. RESULTS All patients were able to void spontaneously with no post-void residual volume of urine. The flow rates increased in all cases (p=0.03) and the International Prostate Symptom Scores were significantly improved after stent insertion in all patients (p=0.03). All patients experienced some degree of pain or dysuria during stent use. CONCLUSIONS Bladder outflow obstruction was effectively treated with the Spanner intraprostatic stent, however pain limited the use of the device in the early post-brachytherapy patient group. Pharmacotherapy, stent design modification, or smaller stent diameter may increase the utility of stents after brachytherapy.

A Novel Method of Obtaining Prostate Tissue for Gene Expression Profiling

Gene expression profiling by DNA microarray analysis is a technique with great promise in cancer biology. The multifocality and heterogeneity of many prostate cancers makes the collection of adequate biological samples for such profiling particularly challenging. Current methods, such as laser capture microdissection, are not widely available and can have significant limitations. In this article, a novel method of prostatic sampling, which does not affect the histopathological assessment of the surgical specimen and provides adequate RNA yield for microarray analysis is described. This method is simple, inexpensive, easily reproducible, and has been validated as having >95% sensitivity and 99% specificity for histological prediction of tissue obtained. This method can be adopted by other investigators to perform DNA microarray analysis on prostate tumors.

Urinary morbidity after 125I brachytherapy of the prostate

Sir I was impressed with the comments in the recent issue by Blaivas [1] and his editorial elsewhere [2]. He pointed out the ambiguity of the definition of the overactive bladder (OAB) compared with Down’s syndrome [1]. He also indicated the ambiguity of the exclusion criteria of OAB ‘if there is no proven infection or other obvious pathology’ [2]. He asked whether the patients with BPH (obvious pathology) have OAB. I would like to offer a suggestion about the exclusion criteria for OAB. As is well-known, there is a similar symptom-based syndrome of evacuation or excretion, the ‘irritable bowel syndrome’ (IBS). In the definition of IBS the exclusion criteria are clearly stated descriptively as ‘red flags’ in the diagnosis of IBS, i.e. occult blood in stool, weight loss, arthritis or dermatitis on physical examination, etc. [3]. Thus we need ‘red flags’ also for the differential diagnosis of OAB. I wonder why the International Continence Society Terminology Committee [4] refer to such a syndrome? They should be able to make more descriptive exclusion criteria like ‘occult blood in urine’ to exclude malignancies. I ‘urge’ the committee to make descriptive exclusion criteria to relieve physicians from the confusion. Otherwise, the symptom-based OAB definition is not a patientor primary care-friendly diagnosis as it is, but rather only a pharmaceutical industry-friendly one.

Improvement in urinary symptoms after radical prostatectomy: a prospective evaluation of flow rates and symptom scores

Sir, We read with interest the report by Masters and Rice [1] on improvements in urinary symptom score after radical prostatectomy. They reported decreases in the IPSS similar to those reported by Schwartz and Lepor [2]. However their conclusion is erroneous; the increases in flow rate and IPSS typical after radical surgery are accompanied by a decrease in continence [2,3] which affects 63–69% of men, with 24–31% requiring long-term pad use when patients report their own outcomes [3,4]. Although the authors accept that the IPSS bother score does not assess quality of life they suggest that the bother score will reflect the effect of incontinence. This has not been established and when studies using the validated UCLA prostate cancer index are used to assess urinary bother, the mean urinary bother score worsens after radical prostatectomy and remains below the baseline score for at least 3 years after surgery [4]. If a significant improvement in urinary bother were routine in the 40% of men who have significant LUTS before radical prostatectomy it should be reflected in improved urinary bother scored on prostate cancer-specific quality-of-life measures, and this has not been the case. Most studies assessing general health-related quality of life after treatment for early prostate cancer show improvements only in emotional and role functioning within the first year, and these changes are not unique to treatment with radical prostatectomy.