Factors predicting for urinary morbidity following 125iodine transperineal prostate brachytherapy
Introduction
Transperineal interstitial permanent prostate brachytherapy (TIPPB) has become a commonly performed procedure for definitive early prostate cancer treatment in North America [21]. This procedure has been taken up in Australia as an alternative to radical prostatectomy in some patients [18]. A number of series with mature follow-up show disease control rates which appear comparable to that achieved with radical prostatectomy in similar patient groups [5], [23].
With equivalent control rates, the choice of treatment depends on the relative morbidities of the various procedures. Lower urinary tract symptoms (LUTS) are a prominent category of morbidity in men undergoing TIPPB [32]. The symptoms include irritative symptoms in the period after implantation, obstructive symptoms sometimes requiring catheterisation, and in the longer term, incontinence [22].
From the onset of a TIPPB program for men with early localised prostate cancer we prospectively collected data on LUTS using a validated and widely employed survey instrument [2], as well as objectively measured urinary flow rates on men prior to implant. We reviewed the incidence, severity and time course of LUTS in men after TIPPB to determine if these morbidities might be predicted by pretreatment or treatment related factors.
Section snippets
Materials and methods
Men with cT1b-T2b, N0, M0 adenocarcinoma prostate (according to AJCC 1997 criteria [6]) with presenting PSA≤10 ng/ml and Gleason score (GS) histopathological pattern of ≤6 were considered for our seed TIPPB program. For this analysis, a cohort of men implanted between December 1998 and December 2003 who had no additional external-beam radiotherapy were chosen. Following routine clinical evaluation, patients filled out self assessment International Prostate Symptom Score (IPSS) questionnaires [2]
Results
One hundred and seventy-three men implanted with TIPPB were eligible for analysis, with a median age of 61 years (range 45–77 years). Median preimplant PSA was 5.8 ng/ml, with 92% having PSA≤10 ng/ml; a further twelve patients had levels between 10.1 and 13.5 ng/ml. One patient had a Gleason score of seven, all others being GS≤6. The clinical staging was T1c in 72 patients, T2a in 67, T2b in 19 and T2c in 15. Four patients had undergone previous transurethral resection of prostate (TURP) for
Acute urinary retention
Acute urinary retention is a morbidity which can affect patient quality of life following TIPPB. Many investigators have attempted to delineate factors which predispose to urinary retention postimplant. Overall reported incidence rates vary between 5 and 35% [3], [4], [9], [10], [14], [17], [20], [25], [26], [27], [29], [30], [32], with the present series showing an 19.7% rate of catheter reinsertion.
Larger prostate volume has been the most uniformly described preimplant risk factor for
Conclusions
AUR is a relatively common complication following prostate TIPPB, occurring mostly within the first two weeks following implantation. This result is consistent with many other published trials. Also similar is the temporal distribution of urinary symptoms assessed by the IPSS. Peak urinary flow rate appears to be a strong predictor for AUR, and is more reliable than IPSS in this regard. The peak in the IPSS response to TIPPB is inversely correlated to the preimplant IPSS, and positively
Acknowledgements
The authors wish to thank Mrs Karen Scott and Dr Janet Havercroft for their contribution in maintenance of the clinical and physics databases respectively.
References (32)
- et al.
The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association
J Urol
(1992) - et al.
Urinary morbidity with a modified peripheral loading technique of transperineal (125)i prostate implantation
Int J Radiat Oncol Biol Phys
(2000) - et al.
Factors influencing risk of acute urinary retention after TRUS-guided permanent prostate seed implantation
Int J Radiat Oncol Biol Phys
(2002) - et al.
High prevalence of benign prostatic hypertrophy in the community
Lancet
(1991) - et al.
Urinary morbidity following ultrasound-guided transperineal prostate seed implantation
Int J Radiat Oncol Biol Phys
(1999) - et al.
Patient reported complications after prostate brachytherapy
J Urol
(2001) - et al.
Transition zone index as a method of assessing benign prostatic hyperplasia: correlation with symptoms, urine flow and detrusor pressure
J Urol
(1995) - et al.
Transition zone index as a risk factor for acute urinary retention in benign prostatic hyperplasia
Urology
(1998) - et al.
Factors predicting for postimplantation urinary retention after permanent prostate brachytherapy
Int J Radiat Oncol Biol Phys
(2000) - et al.
A prospective quality-of-life study in men with clinically localized prostate carcinoma treated with radical prostatectomy, external beam radiotherapy, or interstitial brachytherapy
Int J Radiat Oncol Biol Phys
(2001)
Risk factors for acute urinary retention requiring temporary intermittent catheterization after prostate brachytherapy: a prospective study
Int J Radiat Oncol Biol Phys
Relationship between the transition zone index of the prostate gland and urinary morbidity after brachytherapy
Urology
Temporal resolution of urinary morbidity following prostate brachytherapy
Int J Radiat Oncol Biol Phys
A survey of current clinical practice of permanent prostate brachytherapy in the United States
Int J Radiat Oncol Biol Phys
Prediction of bladder outlet obstruction in men with lower urinary tract symptoms using artificial neural networks
J Urol
Transperineal 125iodine implantation for treatment of clinically localized prostate cancer: 5-year tumor control and morbidity
Int J Radiat Oncol Biol Phys
Cited by (53)
Low dose rate brachytherapy for primary treatment of localized prostate cancer: A systemic review and executive summary of an evidence-based consensus statement
2021, BrachytherapyCitation Excerpt :Studies have reported that patients with higher baseline IPSS scores (>= 15–18) may be at greater risk of acute urinary retention after implant (81,82). Urodynamic testing can be helpful in patients with a higher IPSS score, as those with worse peak flow rate (83,84) and significant post-void residual (85) are at higher risk of postimplant urinary retention and late urinary morbidity. Optimizing urinary function with medications before implant is recommended.
Changes in lower urinary tract symptoms after iodine-125 brachytherapy for prostate cancer
2019, Clinical and Translational Radiation OncologyDecline in acute urinary toxicities with increased institutional experience: 15-year experience of permanent seed prostate brachytherapy in a single Australasian institution
2017, BrachytherapyCitation Excerpt :Although prostate volume is associated with increased risk of AUR in univariate analyses in our study, the association is no longer statistically significant in multivariate analyses. As with our earlier study (9), we reported the peak urinary flow rate to be the only factor independently associated with risk of AUR. However, it seems that few other studies have actually evaluated the association between peak urinary flow rate and the risk of AUR.
Urinary and rectal toxicity profiles after permanent iodine-125 implant brachytherapy in Japanese men: Nationwide J-POPS multi-institutional prospective cohort study
2015, International Journal of Radiation Oncology Biology Physics