Health‐related quality of life after prostate brachytherapy

Abstract

Brachytherapy for prostate cancer has become a widely used treatment. Increasingly, urologists are becoming conscious of quality‐of‐life issues relating to treatment. This mini‐review by authors from the University of Virginia looks at this important issue, reminding readers that patients are often willing to choose a treatment which will less certainly ensure a longer life‐expectancy, but which will more certainly guarantee a better quality of life.Other mini‐reviews in this section describe the technique and complications of transurethral surgery for bladder tumours, the mechanisms of vasculogenic erectile dysfunction after renal transplantation, and laparoscopic radical cystectomy and urinary diversion.

Recto‐urethral fistula following brachytherapy for localized prostate cancer

“…Urinary irritability is the dominant acute side effect, and this is often self‐limiting. Other late complications such as rectal bleeding and low rectal pain will typically peak at 8 months before resolving [4]. Rectal bleeding, when defined as occurring at least once per week over a 1‐month period is reported in 10% of BT patients and is caused by radiation proctitis [11].…”

“…Urinary irritability is the dominant acute side effect, and this is often self-limiting. Other late complications such as rectal bleeding and low rectal pain will typically peak at 8 months before resolving [4].…”

“…Patients often choose BT based on its apparent convenience and more acceptable toxicity profile when compared with EBRT or RRP. For BT, acute side effects include perineal discomfort, irritative voiding symptoms, transient rectal bleeding and altered bowel function [4]. There is a small risk of short-term catheterization which rarely leads to long-term catheterization.…”

“…There is a small risk of short‐term catheterization which rarely leads to long‐term catheterization. Late side effects include urethral strictures, erectile dysfunction, although this is lower when compared with EBRT or RRP, and radiation proctitis [4] including ulceration. A small long‐term increase in bladder and rectal malignancies has been reported following EBRT [5,6].…”

Minimal channel GreenLight photovaporization before permanent implant prostate brachytherapy for patients with obstructive symptoms: Technically feasible and safe

“…However, patients with significant lower urinary tract symptoms (LUTS) are usually not eligible for this treatment despite absence of oncological contraindication and therefore not referred for BrT (7,8). Indeed, LUTS with International Prostate Symptom Score (IPSS) O 12e20, transurethral resection of the prostate (TURP) defects, large median lobes, and/or gland size O50-60 cc are relative contraindications for this technique because usually described as associated with a higher risk of acute urinary retention (AUR) after BrT (2e22%), or with increasing LUTS (1,7,9,10). The American Urological Association, along with the American Society for Radiation Oncology in their 2017 guidelines also advise against the use of BrT for patients with previous TURP or obstructive symptoms.…”