Temporal resolution of urinary morbidity following prostate brachytherapy

Purpose: To report the short-term urinary morbidity for prostate brachyther apy patients without a preimplant history of a transurethral resection of t he prostate gland and who received prophylactic and prolonged alpha-blocker s. alpha-blockers may decrease radiation-induced urethritis and increase ur inary how, Multiple clinical and treatment parameters were evaluated to ide ntify factors associated with increased acute urinary morbidity, Materials and Methods: One hundred seventy consecutive patients without a p rior history of a transurethral resection of the prostate gland underwent t ransperineal ultrasound guided prostate brachytherapy for clinical T1c-T3a carcinoma of the prostate gland. For all patients, an alpha-blocker was ini tiated prior to implantation and continued at least until the international prostate symptom score (IPSS) returned to baseline levels. Clinical parame ters evaluated for short-term urinary morbidity included patient age, clini cal T stage, preimplant IPSS (obtained within 3 weeks of implantation), and prostate ultrasound volume. Treatment parameters included the utilization of neoadjuvant hormonal manipulation, the utilization of moderate dose exte rnal beam radiation therapy before implantation, the choice of isotope, the urethral dose, the total implant activity in millicuries, and a variety of dosimetric quality indicators (D-90 and V-100/V-150/V-200). Catheter depen dency and the duration of alpha-blocker dependency was also evaluated. On a verage, 11.2 IPSS surveys were obtained for each patient. Results: One hundred fifty of the 170 patients (88.2%) had the urinary cath eter permanently removed on day 0. Only one patient required an urinary cat heter for > 5 days. Two patients (1.2%) required a subsequent transurethral resection of the prostate gland because of prolonged obstructive/irritativ e symptoms. To date, no patient has developed an urinary stricture or urina ry incontinence. The IPS score on average peaked at 2 weeks following impla ntation, This score returned to within 1 point of the antecedent value at a median of 6 weeks and a mean of 13.3 weeks. At 26 and 50 weeks, 85% and 56 % of the patients, respectively, continued with alpha-blockers. Of the clin ical and treatment parameters evaluated for short-term urinary morbidity, o nly variants of the IPSS such as the maximum, maximum increase, and preimpl ant IPSS values correlated with time to return to the referent zone with p < 0.05. Conclusion: The return of the IPS score to baseline occurred more rapidly i n our series than what has previously been reported. The 1.2% incidence of transurethral resections also compares favorably with the published literat ure. We believe these results may be due to maintaining the average urethra l dose to approximately 115% of the prescribed dose and the prophylactic an d long-term use of alpha-blockers. (C) 2000 Elsevier Science Inc.