Rectal function following prostate brachytherapy

Purpose: Quality of life following therapeutic intervention for carcinoma o f the prostate gland has not been well documented. In particular, a paucity of data has been published regarding bowel function following prostate bra chytherapy. This study evaluated late bowel function in 209 consecutive pro state brachytherapy patients via a one-time questionnaire administered 16-5 5 months postimplant. Materials and Methods: Two hundred nineteen consecutive patients underwent permanent prostate brachytherapy from April 1995 through February 1998 usin g either I-125 Or Pd-103 for clinical T1c-T3a carcinoma of the prostate gla nd. Of the 219 patients, 7 had expired. Of the remaining 212 patients (medi an follow-up, 28 months), each patient was mailed a self-administered quest ionnaire (10 questions) with a prestamped return envelope; 209 (98.6%) surv eys were returned. Clinical parameters evaluated for bowel dysfunction incl uded patient age, diabetes, hypertension, history of tobacco consumption, c linical T-stage, elapsed time since implant, and prostate ultrasound volume . Treatment parameters included utilization of neoadjuvant hormonal manipul ation, utilization of moderate dose external beam radiation therapy prior t o implantation, choice of isotope (125I vs. 103Pd), rectal dose (average, m edian and maximum doses), total implanted seed strength, values of the mini mum dose received by 90% of the prostate gland (D-90) and the percent prost ate volume receiving 100%, 150%, and 200% of the prescribed minimum periphe ral dose (V-100, V-150 and V-200, respectively). Because detailed baseline bowel function was not available for these patients, a cross-sectional surv ey was performed in which 30 newly diagnosed prostate cancer patients of co mparable demographics served as controls. Results: The total rectal function scores for the brachytherapy and control patients were 4.3 and 1.6, respectively, out of a total 27 points (p < 0.0 01). Of the evaluated clinical parameters, only the preimplant number of bo wel movements per day were correlated with the total survey score (p < 0.01 ). None of the treatment parameters were significantly correlated with the total survey score. Despite the fact that implantation with Pd-103 resulted in lower radiation doses to the rectum, the choice of isotope was not pred ictive of bowel function scores. A trend toward increased rectal scores was noted for older patients, and a nonsignificant improvement in rectal surve y scores was noted with elapsed time from implantation. Only 19.2% (40/208) of the treatment group reported a worsening of bowel function following im plantation. Patient perception of overall rectal quality of life, however, was inversely related to the utilization of external beam radiation therapy (p = 0.034). Conclusion: To date, no severe changes in late bowel function have been not ed following prostate brachytherapy. Although the survey scores indicate bo wel function is worse after an implant, the minor changes are not significa nt enough to bother most individuals. Less than 20% of patients reported th at their bowel function was worse following prostate brachytherapy. (C) 200 0 Elsevier Science Inc.