Various selection criteria are used in the recommendation for PB. Because of anatomic constraints, larger prostate volumes are a relative contraindication for permanent PB. As the volume of the prostate gland increases, the risk of pubic arch interference increases. Many investigators use a volume cut-off volume around 50 cm3 in order to select appropriate candidates for PB. However, various intraoperative techniques are possible to gain access to the prostate gland's periphery in a tightly constrained pelvis. One option is to increase the hip flexion to a maximal dorsal lithotomy position. Alternatively, the ultrasound probe and needle trajectory can be angled more anteriorly to get under the pubic bone. In addition to technical difficulties, some investigators have reported worse urinary toxicity in men with larger glands.
Some investigators argue that a history of a TURP is a relative contraindication to PB. Although initial reports suggested an increased incidence of urinary incontinence in men with a prior history of a TURP, recent reports do not substantiate. Different rates of toxicity between investigators are likely secondary to different degrees of a TURP defect in reported patients. The authors of this chapter judge each patient's case separately, avoiding PB in men with very large TURP defects.
Although inflammatory bowel disease is a contraindication to those men undergoing EBRT for prostate cancer, owing to the significant rate of GI toxicity, bowel disease has not been shown to influence the toxicity of PB. Wallner etal.14 reported on six patients with inflammatory bowel disease undergoing PB and did not find an increased incidence of GI toxicity.
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