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Editorial Comment to Impact of pre‐implant lower urinary tract symptoms on postoperative urinary morbidity after permanent prostate brachytherapy

Teishima et al. present interesting results regarding urinary morbidity after permanent prostate brachytherapy. The strengths of their study include a prospective design using validated questionnaires to distinguish between the outcomes of patients with mild pre-implant lower urinary tract symptoms (LUTS) versus moderate to severe LUTS. One of the major concerns of patients undergoing brachytherapy is treatment-related LUTS. This evaluation was carried out on 104 Japanese patients with prostate cancer whose urinary morbidity was assessed using the International Prostate Symptom Score (IPSS) and Expanded Prostate Cancer Index Composite (EPIC) for at least 12 months after brachytherapy. The authors observed a worsening in LUTS 1–3 months after treatment, but a return of the mean IPSS (irritative and obstructive) and EPIC almost to baseline within 12 months in both groups of patients with either lowor high-IPSS. One of the explanations for full recovery might be related to the fact that none of the study patients used alpha-blockers before brachytherapy, and all received alpha-blockers until urinary recovery. Many studies have reported on urinary morbidity after brachytherapy; however, in this study the authors dissected the influence of the degree of pre-implant LUTS on the “kinetics” of all urinary complaints after treatment. Although the study was carried out on a small number of patients, it adds important information to a selection of patients with pre-implant LUTS who are willing to undergo prostate brachytherapy. Most patients can be reassured that after the acute morbidity expected during the immediate postoperative course, almost a complete recovery to baseline within 12 months is expected regardless of pre-implant LUTS severity.