UROLOGICAL SURVEY
Reconstructive Urology
Urinary side effects and complications after permanent prostate brachytherapy: the MD Anderson Cancer Center experience
Anderson JF, Swanson DA, Levy LB, Kuban DA, Lee AK, Kudchadker R, Phan J, Bruno T, Frank SJ
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
Urology. 2009; 74: 601-5
OBJECTIVES: To evaluate acute and long-term urinary morbidity after permanent prostate brachytherapy at a single tertiary care center. To minimize the risk of long-term urinary morbidity, it is important for clinicians to be able to distinguish acute urinary side effects after prostate brachytherapy from longer-term treatment-related urinary complications.
METHODS: The medical records of 351 consecutive patients who underwent prostate brachytherapy at the MD Anderson Cancer Center between 1998 and 2006 were analyzed. To evaluate the short-term urinary side effects, the Expanded Prostate Cancer Index Composite questionnaire was administered at baseline and at 1,4,8, and 12 months. Long-term urinary complications were scored using a modified Radiation Therapy Oncology Group scale.
RESULTS: All 4 urinary subdomain scores evaluating acute urinary side effects after treatment (bother, function, incontinence, and irritation or obstruction) had returned to baseline levels by 8 months after implantation. At 5 years, the cumulative risks of late urinary complications by grade were 8.6% for grade 1 complications, 6.5% for grade 2, 1.7% for grade 3%, and 0.5% for grade 4. The most common grade 2 late urinary complications were urethral stricture (4 patients), incontinence requiring daily pads (3 patients), and intermittent hematuria (3 patients). Grade 3 complications were urinary retention requiring self-catheterization (2 patients) and severe frequency with dysuria (2 patients). The only grade 4 event was severe hemorrhagic cystitis.
CONCLUSIONS: Short-term urinary side effects after prostate brachytherapy are common, follow a predictable course, and typically resolve within 1 year. Conservative management of short-term urinary side effects is recommended to minimize the risk of long-term urinary complications.
Editorial Comment
The authors describe the cumulative incidence of acute urinary side effects and delayed urinary complications of prostate brachytherapy. The cumulative incidence of urethral stricture was similar to what has been previously reported - just under 5% (1). A review of the grade 2-4 complications reveals them all to be problems that are very difficult to manage. Urethral strictures in radiated tissue rarely have a durable response to optical urethrotomy. Urinary incontinence after brachytherapy is much more troublesome to treat than after radical prostatectomy. Moderate to severe dysuria has no good solution. When examining Figure-2 in the article - a graph of the cumulative incidence of late urinary complications - one sees a trend common to most radiation series. That trend is that complications continue to accrue at a steady rate through the end of the follow-up period. To measure the true risk of these complications the follow-up needs to be carried out much further. Urethral complications of radiation therapy are not rare and continue to be a vexing problem to manage.
Dr. Sean P. Elliott
Department of Urology Surgery
University of Minnesota
Minneapolis, Minnesota, USA
E-mail: selliott@umn.edu
- 1. Elliott SP, Meng MV, Elkin EP, McAninch JW, Duchane J, Carroll PR; CaPSURE Investigators: Incidence of urethral stricture after primary treatment for prostate cancer: data From CaPSURE. J Urol. 2007; 178: 529-34; discussion 534.
Publication Dates
-
Publication in this collection
21 Jan 2010 -
Date of issue
Dec 2009
