To investigate current practices in assessment and management of patients with known LUTS before and after referral for prostate cancer radiotherapy. To assess feasibility of current NICE guidance on 3 follow up appointments under Urology post radiotherapy for LUTS assesment and what current practice is.

We have retrospectively reviewed 160 patients referred locally for prostate cancer radiotherapy in our unit and explored what preassessment for LUTS had happened before initiation of radiotherapy. We investigated whether the practice changed if these patients had known bladder outflow obstruction beforehand and whether pharmacological or surgical interventions were implemented before the radiotherapy. Furthermore we looked at change in management and IPSS scores or flow rates after radiotherapy to assess trend changes. Finally we performed a literature review of trends in LUTS management before and after prostate radiotherapy.

40% of patients had LUTS preassessment which included Urologist clinic review, flow rate and IPSS score. 90% of these patients were started on either mono or dual therapy of Tamsulosin and Finasteride. 65% of these patients needed escalation of management after radiotherapy with the majority continuing to suffer from LUTS or incontinence despite Bladder Outflow Obstruction surgery.

Literature review suggests no agreed protocol for management of LUTS before prostate radiotherapy and not enough data to be statistically significant on best approach. It is hypothesised however that in patients with known BOO beforehand should undergo Channel TURP or a minimally invasive procedure such as Urolift to manage outflow obstruction before radiotherapy is given.

There is currently no standardised protocol on addressing patients with LUTS before radiotherapy but we propose a mandatory Urologist assesment before referral for radiotherapy which includes flow studies, IPSS score and post void residual scans. Patients can then be selected to undergo urgent BOO surgery before having their prostate radiotherapy. These patients should then be followed up at 3 and 6 months after radiotherapy by a Urologist for LUTS assessment.

https://auanews.net/issues/articles/2024/march-2024/management-of-outlet-obstruction-before-and-after-radiation-therapy-for-prostate-cancer
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