Brachytherapy‐related dysuria

• Published in: BJU international Vol. 95; no. 4; pp. 597 - 602
• Main Authors: Merrick, Gregory S., Butler, Wayne M., Wallner, Kent E., Allen, Zachariah, Galbreath, Robert W., Lief, Jonathan H.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.03.2005; Blackwell
• Subjects: Adrenergic alpha-Antagonists - therapeutic use; Aged; Antineoplastic Agents - therapeutic use; Biological and medical sciences; brachytherapy; Brachytherapy - adverse effects; dysuria; Follow-Up Studies; Genital system. Mammary gland; Humans; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Prospective Studies; prostate; Prostatic Neoplasms - radiotherapy; Quality of Life; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Severity of Illness Index; Sulfonamides - therapeutic use; Treatment Outcome; urinary morbidity; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urination Disorders - drug therapy; Urination Disorders - etiology; Human; urinary morbidity; Nephrology; Urinary system disease; Prostate disease; Malignant tumor; Radiotherapy; Prostate adenocarcinoma; Urology; Quality of life; Voiding dysfunction; Treatment; Radiation injury; Complication; prostate; brachytherapy; Male genital diseases; Prostate cancer; Curietherapy; Dysuria
• DOI: 10.1111/j.1464-410X.2005.05346.x
• ISSN: 1464-4096

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 103Pd or 125I 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, V100/200, D90, 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 103Pd 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.