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Factors influencing long‐term urinary symptoms after prostate brachytherapy
Author(s) -
Stone Nelson N.,
Winoker Jared S.,
Kaplan Steven A.,
Stock Richard G.
Publication year - 2018
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14365
Subject(s) - medicine , prostate cancer , brachytherapy , urology , proportional hazards model , hazard ratio , prostate , prostate brachytherapy , radiation therapy , gynecology , cancer , confidence interval
Objectives To determine which patient and treatment‐related factors are associated with increased American Urological Association symptom score ( AUASS ) in men who presented with minimal symptoms before treatment for prostate cancer by permanent seed implantation. Patients and Methods Of 1842 men with a minimum follow‐up of 5 years (mean 9.4), 1110 (60.3%) had an initial AUASS of 0–7 and were treated with brachytherapy ( BT ) alone ( n = 491) or BT with neoadjuvant hormone therapy ( NHT ) and/or external beam radiation therapy ( EBRT , n = 619). The median prostate volume was 37 mL . Data were prospectively collected on comorbidities. Initial AUASS was compared to last using a Student's t ‐test (two‐tailed). Freedom from increasing from minimal to moderate or severe symptoms was determined by the Kaplan–Meier method with comparisons by log‐rank and Cox hazard rates ( HR s). Results The change from pre‐treatment score for the minimal, moderate and severe symptom groups was: 3.6–7.3 ( P < 0.001), 11.6–11.3 ( P = 0.426), and 24.1–16.9 ( P < 0.001). For those with minimal symptoms the 10‐ and 15‐year estimates for freedom from worse symptoms were 72.9% and 39.1%, respectively. Cox HR s were significant for EBRT boost ( HR 1.45, P = 0.004), RT dose >200 Gy 2 ( HR 1.25, P = 0.024), hypertension ( HR 1.37, P = 0.006), and alcohol use ( HR 1.46, P = 0.001). Conclusion A substantial number of men with initial low AUASS treated by BT experience worsening urinary symptoms with long‐term follow‐up. Use of EBRT , RT dose, hypertension and alcohol use are risk factors for an increase in urinary symptom score.