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Brachytherapy‐related dysuria
Author(s) -
Merrick Gregory S.,
Butler Wayne M.,
Wallner Kent E.,
Allen Zachariah,
Galbreath Robert W.,
Lief Jonathan H.
Publication year - 2005
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/j.1464-410x.2005.05346.x
Subject(s) - dysuria , medicine , brachytherapy , urology , international prostate symptom score , tamsulosin , prostate cancer , prostate brachytherapy , urination disorder , prostate , urinary retention , prospective cohort study , lower urinary tract symptoms , surgery , urinary system , radiation therapy , cancer , hyperplasia
OBJECTIVE To evaluate the incidence and temporal resolution of dysuria after permanent prostate brachytherapy, and to identify predictors of brachytherapy‐related dysuria. PATIENTS AND METHODS The study included 130 patients with no history of transurethral resection of the prostate before treatment, who had brachytherapy on one of two prospective randomized trials, with explicitly planned and executed urethral‐sparing techniques (100–150% minimum peripheral dose) using either 103 Pd or 125 I for clinical T1c–T2c prostate cancer. The median follow‐up was 22.6 months. An α‐blocker was initiated either prophylactically 2 weeks before implantation and continued at least until the International Prostate Symptom Score (IPSS) returned to normal, or withheld until the onset of significant brachytherapy‐related urinary morbidity. Dysuria was evaluated on a 0–10 scale, before brachytherapy and then at 1, 3, 6 and 12 months afterward, with a median of four dysuria questionnaires per patient. Clinical, treatment and dosimetric variables evaluated included α‐blocker, age, IPSS before and the maximum after treatment, prostate volume on ultrasonography, hormonal status, supplemental radiotherapy, isotope, urethral dose, V 100/200 , D 90 , and time to obtaining a normal IPSS. RESULTS The maximum incidence of dysuria was 85% at 1 month after brachytherapy, with subsequent resolution over time. The use of prophylactic tamsulosin resulted in a statistically lower dysuria severity score (difference of 2.7 vs 4.2, P < 0.005) at 1 month, with no discernible differences at 3, 6, 12 and 18 months. Patients with dysuria had a statistically higher IPSS. The dysuria resolved faster in patients implanted with 103 Pd but was unaffected by the use of supplemental radiotherapy and/or androgen deprivation therapy. In multivariate analysis, prophylactic α‐blockers resulted in statistically lower maximum dysuria scores, while the maximum IPSS after implantation and isotope type (but only at 6 months) were the best predictors of the resolution of dysuria. CONCLUSIONS Dysuria is common after brachytherapy but is typically mild. Prophylactic α‐blockers gave significantly lower maximum dysuria scores but did not affect the time to the resolution of dysuria. The maximum IPSS after the implant was the best predictor of the resolution of dysuria.