Prostate brachytherapy in patients with median lobe hyperplasia

Our aim was to document the technical and clinical course of prostate brach ytherapy patients with radiographic evidence of median lobe hyperplasia (ML H). Eight patients with MLH were identified during our routine brachytherap y practice, representing 9% of the 87 brachytherapy patients treated during a 6-month period. No effort was made to avoid brachytherapy in patients no ted to have MLH on diagnostic work-up. Cystoscopic evaluation was not routi nely performed. Postimplant axial computed tomographic (CT) images of the p rostate were obtained at 0.5 cm intervals. Preimplant urinary obstructive s ymptoms were quantified by the criteria of the American Urologic Associatio n (AUA). Each patient was contacted during the writing of this report to up date postimplant morbidity information. There was no apparent association b etween the degree of MLH and preimplant prostate volume or AUA score. Intra operatively, we were able to visualize MLH by transrectal ultrasound and di d not notice any particular difficulty placing sources in the MLH tissue or migration of sources out of the tissue. The prescription isodose covered f rom 81% to 99% of the postimplant CT-defined target volume, achieving adequ ate dose to the median lobe tissue in all patients. Two of the eight patien ts developed acute, postimplant urinary retention. The first patient requir ed intermittent self-catheterization for 3 months and then resumed spontane ous urination. MLH does not appear to be a strong contraindication to prost ate brachytherapy, and prophylactic resection of hypertrophic tissue in suc h patients is probably not warranted. (C) 2000 Wiley-Liss, Inc.