Bladder outlet obstruction surgery in patients undergoing radiation therapy for prostate cancer: Adverse events, functional outcomes and quality of life - A scoping review

Introduction: Lower urinary tract symptoms are common in patients with prostate cancer that undergo radiotherapy. Here, we summarize evidence concerning genitourinary toxicity, lower urinary tract function and quality of life in patients with bladder outlet obstruction prior- and post prostate radiation. Methods: Pubmed, Cochrane and Medline (OVID) were searched for relevant articles concerning genitourinary toxicity, lower urinary tract function and quality of life in patients with prior and post radiation undergoing desobstructive surgery. 529 articles were found, of which 29 were selected. Results: 17 studies reported outcomes in patients undergoing desobstructive surgery before radiotherapy. For urinary adverse events data was inconclusive with some studies suggesting no difference in early or late toxicity (n = 4), while others suggested increased toxicity after desobstruction (n = 4). Studies serially assessing the international prostate symptom score did not find significant differences between baseline and last follow-up for patients with a history of prior transurethral resection of the prostate. 3 studies described favorable outcomes of neo-adjuvant desobstruction in patients undergoing brachytherapy. Although little data is available, bladder outlet obstruction surgery after radiotherapy is associated with high rates of toxicity (such as incontinence). Conclusion: There is insufficient evidence to strongly suggest increased toxicity and/or diminished lower urinary tract function in patients receiving radiotherapy after desobstructive surgery. Furthermore, desobstruction after radiotherapy is unfavorable. Additional research is needed to assess whether neoadjuvant desobstruction is protective against genitourinary toxicity and lower urinary tract dysfunction after radiation therapy.