When compared with conventional external beam radiotherapy, hypofractionated radiotherapy has led to less treatment sessions and improved quality of life without compromising oncological outcomes for men with prostate cancer. Evidence has shown transurethral prostatic resection prior to brachytherapy and external beam radiotherapy is associated with worsening genitourinary toxicity. However, there is no review of genitourinary toxicity when TURP occurs prior to definitive hypofractionated radiotherapy. In this review, we seek to illustrate the genitourinary outcomes for men with symptoms of bladder outlet obstruction with localized prostate cancer who underwent transurethral resection of the prostate prior to receiving definitive hypofractionated radiotherapy. Genitourinary outcomes are explored and any predictive risk factors inclusive of the key surgical, radiation and patient factors for increased genitourinary toxicity are described.

PubMed, Medline (Ovid), EMBASE and Cochrane Library were all searched for relevant articles published in English within the last 25 years. This scoping review identified a total of 579 articles. Following screening by authors, 11 articles were included for analysis.

Five studies reported on acute (<90 days post radiotherapy) and late toxicity (>90 days post radiotherapy). One article reported only acute toxicity while five documented late toxicity only. While most articles found no increased risk of acute toxicity, the risk of late toxicity particularly hematuria was noted to be significant. Risk factors including poor baseline urinary function (IPSS >19), baseline prostate volume (>35cc), number of prior transurethral prostatic resections (> 1 prior TURP), timing of radiotherapy following transurethral prostatic resection, volume of the intraprostatic resection cavity >2.6cm3 and mean dose delivered to the cavity were all found to influence genitourinary outcomes.

For those who have undergone prior TURP, hypofractionated radiotherapy may increase the risk of late urinary toxicity, particularly hematuria. Those with persisting bladder dysfunction following TURP are at greatest risk and careful management of these men is required. Close collaboration between urologists and radiation oncologists is recommended to discuss the management of patients of these patients with residual baseline bladder dysfunction prior to commencing hypofractionated radiotherapy.