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RECONSTRUCTIVE
UROLGY
doi: 10.1590/S1677-553820090006000024
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.
Reference
- 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.
Dr.
Sean P. Elliott
Department of Urology Surgery
University of Minnesota
Minneapolis, Minnesota, USA
E-mail: selliott@umn.edu
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