International Journal of Radiation Oncology*Biology*Physics
Clinical investigation: prostateFactors influencing risk of acute urinary retention after TRUS-guided permanent prostate seed implantation
Introduction
Permanent seed prostate brachytherapy is becoming an increasingly popular option in the management of clinically localized prostate cancer. It is estimated that in 2001, >50% of American Medicare patients with newly diagnosed localized prostate cancer will have been treated with brachytherapy. By 2005, 50% of all appropriate newly diagnosed cases will receive brachytherapy (1). This option is often perceived as having a better side effect profile than radical prostatectomy. Nonetheless, a significant proportion of men will experience prolonged urinary dysfunction. Acute urinary retention (AUR) rates generally range from 5% to 15% and may result in a prolonged period of catheterization, intermittent self-catheterization, a suprapubic tube, or even a transurethral resection, if persistent. This can have a major impact on quality of life for the individual. The ability to predict more severe urinary toxicity would be beneficial in counseling patients who are trying to make a treatment choice.
We report the experience at the Princess Margaret Hospital/University Health Network with 150 permanent seed implants.
Section snippets
Methods and materials
Permanent radioactive seed implantation as management for early-stage localized prostate cancer was approved and funded by the Ministry of Health in the Province of Ontario in February 1999. Provincial evidence-based guidelines (2) developed by the Cancercare Ontario Provincial Guidelines Group (genitourinary division) restrict the availability to appropriately selected patients (Stage T1c/T2a, Gleason score ≤6, prostate-specific antigen [PSA] level <10 ng/mL). From March 1999 to February 2001,
Results
The median follow-up was 13 months (range 3–27). The rate of urinary retention requiring catheterization after implantation was 13% (20 of 150). The time of onset was variable, but most occurred soon after implantation, 6 within the first 24 h, 9 between Days 2 and 7, and 2 in the second week. The remaining 3 were late onset at 2, 5, and 5 months. Two of these men continued intermittent self-catheterization for 18 months. The third was catheterized for severe urinary symptoms, but was not in
Discussion
The popularity of prostate brachytherapy is partially attributable to a perceived favorable toxicity profile. Some degree of urinary morbidity related to urethritis and prostatitis is common in the postimplant period. Symptoms tend to peak at about 2 months (10), with maximal IPSS at 1 month (11), but improve with time, as do function and bother scores (12). Severe long-term urinary morbidity is reported in 3–12%. Health-related quality of life returns to near baseline by 3 months (13), and
Conclusions
AUR is the most common adverse event after permanent seed, low-dose-rate prostate brachytherapy. Prior knowledge of an individual’s relative risk of AUR would be useful in counseling patients before the procedure. In this series of 150 consecutive implants, prostate volume and the use of prior hormonal therapy to downsize the prostate were independent predictors of AUR. The systematic use of the IPSS questionnaire to screen patients and to direct those with significant lower urinary tract
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