The influence of isotope and prostate volume on urinary morbidity after prostate brachytherapy

Niehaus, Angela G.; Merrick, Gregory S.; Wallner, Kent E.; Allen, Zachariah A.; Galbreath, Robert W.; Adamovich, Edward

doi:10.1016/j.ijrobp.2005.06.035

Cited by 49 publications

(34 citation statements)

References 15 publications

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“…Many series have shown that the pre-implant IPSS represents a robust predictor for the time to IPSS resolution [3,5,6,10], while time to IPSS resolution also appears to be directly correlated with prophylactic and prolonged α-blocker usage [3,8,10,20,21]. Consistent with the present study (Fig.…”

Section: Discussionsupporting

confidence: 91%

“…Consistent with the present findings, Crook et al [10] reported that the pre-implant IPSS did not predict urinary retention (6.4 vs 5.9), while the findings were similar in a prospective study [7]. Pre-implant prostate size may be a better predictor for brachytherapy-related urinary retention [6,10,23,24].…”

Section: Discussionsupporting

confidence: 89%

“…Permanent prostate brachytherapy is dominated by urinary irritative/obstructive symptoms, with 2-32% of patients developing urinary retention [1][2][3][4][5][6][7][8][9]. Although most brachytherapists use the IPSS before brachytherapy as a tool to select patients [1], the relationship between the pre-implant IPSS and brachytherapy-related urinary morbidity remains controversial.…”

Section: Introductionmentioning

confidence: 99%

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Severity categories of the International Prostate Symptom Score before, and urinary morbidity after, permanent prostate brachytherapy

Gutman¹,

Merrick²,

Butler³

et al. 2005

BJU International

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OBJECTIVE To determine if the International Prostate Symptom Score (IPSS) before seed implantation, stratified into mild (0–7), moderate (8–19) and severe (>20) categories, predicts brachytherapy‐related morbidity in terms of IPSS resolution, catheter dependency and the need for surgical intervention after brachytherapy. PATIENTS AND METHODS From January 1998 to September 2003, 1034 consecutive patients had permanent interstitial brachytherapy for clinical stage T1b‐T3a NXM0 (2002 system) prostate cancer. Of the 1034 patients, 739 (71.5%) presented with an IPSS of 0–7, 287 (27.7%) of 8–19, and eight (0.8%) of ≥ 20. The IPSS 8–19 cohort was further stratified into 8–14 (237 men) and 15–19 (50 men) subgroups. The median follow‐up was 38.2 months. In all patients, an α‐blocker was initiated before brachytherapy and continued at least until the IPSS normalized, the latter defined as a return to within 1 point of that before implantation. A median of 21 IPSS questionnaires were obtained per patient. Several clinical, treatment and dosimetric variables were evaluated as predictors of urinary morbidity. RESULTS For the entire cohort, the IPSS peaked at a mean of 0.5 months after implantation and resolved at a mean of 1.7 months. At 5 years after brachytherapy, 90.1% of patients at risk (88.8%, 95.5%, and four of eight patients with a pre‐implant IPSS of 0–7, 8–19 and ≥ 20, respectively) were within the IPSS 0–7 category. Compared to the pre‐implant IPSS, 13 patients (8%) were assigned to a higher IPSS severity category. Neither prolonged urinary catheter dependency (>5 days; 16 patients, 1.5%) or transurethral resection of the prostate (TURP, 17 patients, 1.6%) depended on the pre‐implant IPSS subgroup. In Cox regression analysis, IPSS resolution was best predicted by pre‐implant IPSS, prolonged catheter dependency by patient age, and TURP by any catheter dependency, the maximum IPSS increase and the maximum urethral dose. CONCLUSIONS The IPSS before implantation predicted the resolution of IPSS after brachytherapy, but did not correlate with substantial urinary morbidity, including catheter dependency or the need for TURP. At 5 years after brachytherapy, 90.1% of patients at risk were assigned to the IPSS 0–7 category.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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Severity categories of the International Prostate Symptom Score before, and urinary morbidity after, permanent prostate brachytherapy

Gutman¹,

Merrick²,

Butler³

et al. 2005

BJU International

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“…Nevertheless, severe acute urinary toxicity (AUT) such as irritative voiding symptoms and occasional prolonged catheterisation remain as common side effects (Bittner et al 2007). Therefore, it is important to assess severe AUT and clarify the clinical and treatment factors related to severe AUT (Wallner et al 2002;Beekman et al 2005;Niehaus et al 2006;Bittner et al 2007). In addition, the inclusion of patient-reported toxicity data was reported to provide more detailed assessment of AUT (Namiki et al 2006;Ash et al 2007;Ferrer et al 2008).…”

mentioning

confidence: 99%

Predicting the Severity of Acute Urinary Toxicity after Brachytherapy with Iodine-125 for Localized Prostate Cancer

Takeda

Jingu

Koto

et al. 2011

Tohoku J. Exp. Med.

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Prostate cancer is one of the common cancers in the world. In Japan, prostate brachytherapy (PB) with iodine-125 has become a treatment option for localized prostate cancer since 2003. Nevertheless, severe acute urinary toxicity (AUT) remains as one of the intractable side effects. We assessed AUT and the changes in international prostate symptom score (IPSS) before and after PB for localized prostate cancer. IPSS is a questionnaire tool for tracking the subjective urinary symptoms. Between 2006 and 2009, 104 eligible patients underwent PB with iodine-125 were analyzed. AUT was graded with the radiation therapy oncology group (RTOG) scale. Eligible patients filled out IPSS questionnaires before and after PB. Clinical and treatment-related factors were examined for correlation with the severity of AUT and the interval to IPSS resolution. AUT of RTOG Grade 0 (no changes) and Grade 2 was detected in one and 96 patients, respectively, whereas seven patients (6.7%) experienced AUT of Grade 3. Thus, the incidence of severe AUT (Grade 3) after PB was low. A greater number of needles ( p = 0.012) were associated with AUT of RTOG Grade 3 on the univariate analysis. The median interval to IPSS resolution was 6 months (7 ± 6 months). Greater post-implant maximal IPSS ( p < 0.001) was associated with slower IPSS resolution, whereas higher pre-implant IPSS ( p < 0.001) was associated with faster IPSS resolution on the multivariate analysis. In conclusion, reducing the number of needles in PB may be helpful for decreasing the rate of severe AUT.

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“…Also a decrease in the urinary flow curve [4,5] and loss of quality of life [3] can be observed. Approximately 15% of the patients develop severe OVS and the incidence rate of urinary retention varies from 0 to 36% [4,6,7,8,9,10]. In the patients with persisting OVS, an alpha-blocker, (clean intermittent) catheterisation or a transurethral resection of the prostate (TURP) can be a therapeutic option.…”

Section: Introductionmentioning

confidence: 99%

The Use of a Memokath Prostatic Stent for Obstructive Voiding Symptoms after Brachytherapy

Graaf¹,

Stijns²,

Scheepens³

et al. 2013

Current Urology

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Introduction: Brachytherapy may be complicated by serious obstructive voiding symptoms (OVS). Only conservative treatment options are available in the first 6 months after brachytherapy. We evaluated safety, efficacy and patient tolerance of the Memokath prostatic stent (MPS). Material and Methods: A MPS was placed in 10 patients with OVS after brachytherapy. Evaluation included uroflowmetry, international prostate symptom score (IPSS), prostate volume and urethrocystoscopy before and 3 months after placement of the stent. Results: Both the IPSS and uroflowmetry results significantly improved after stent insertion. The mean IPSS decreased from 29/5 to 11/1 and the mean Qmax from the uroflowmetry improved from 4.7 to 11.2 ml/s. The 5 patients who were catheter dependent voided spontaneously with a mean Qmax of 15 ml/s. Two stents migrated towards the bladder, and those patients needed a second stent which was placed without complications. Removal of the stent was easy to perform. Adverse effects were minor with perineal pain and irritative voiding symptoms occurring in 5 patients mainly in the first weeks after insertion. This did not negatively influence quality of life and all patients were more satisfied with the stent than without. Conclusions: The MPS provides a safe, effective, and completely reversible treatment for patients with OVS after brachytherapy and was well tolerated.

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The influence of isotope and prostate volume on urinary morbidity after prostate brachytherapy

Cited by 49 publications

References 15 publications

Severity categories of the International Prostate Symptom Score before, and urinary morbidity after, permanent prostate brachytherapy

Severity categories of the International Prostate Symptom Score before, and urinary morbidity after, permanent prostate brachytherapy

Predicting the Severity of Acute Urinary Toxicity after Brachytherapy with Iodine-125 for Localized Prostate Cancer

The Use of a Memokath Prostatic Stent for Obstructive Voiding Symptoms after Brachytherapy

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