title: Permanent prostate brachytherapy-induced morbidity in patients with grade II and III obesity.
abstract: OBJECTIVE
  To determine the influence of obesity on the development of urinary, bowel, and sexual dysfunction after brachytherapy by means of patient-administered questionnaires. The effect of obesity on dosimetric quality and biochemical outcome was also evaluated.
  
  
  METHODS
  Thirty-two patients with grade II and III obesity underwent brachytherapy from June 1997 through April 2001. Grade II and III obesity was defined as a body mass index of 35.0 to 39.9 and 40.0 kg/m2 or greater, respectively. Serial International Prostate Symptom Score (IPSS) evaluations were obtained at predetermined intervals. Bowel and sexual function were assessed by a rectal function assessment score (R-FAS) and the specific erectile questions of the International Index of Erectile Function (IIEF). The median follow-up was 26.4 months. An alpha-blocker was initiated before implantation and continued at least until the IPSS normalized. Catheter dependency, alpha-blocker dependency, and the incidence of urethral strictures were also evaluated. The efficacy of sildenafil in brachytherapy-induced erectile dysfunction was also evaluated. Dosimetric parameters evaluated included the percentage of the prostate receiving 100%, 150%, and 200% of the prescribed dose (V100, V150, and V200), the minimal dose received by 90% of the prostate (D90), urethral doses, and rectal doses. Biochemical outcome was determined by the ASTRO consensus conference definition.
  
  
  RESULTS
  Of the 32 patients, 31 (97%) had the urinary catheter permanently removed on day 0, and no patient required a urinary catheter for longer than 1 day. One patient developed a urethral stricture. No patient required a transurethral resection or developed urinary incontinence. On average, the IPSS peaked 2 weeks after implantation and returned to baseline at a median of 8 weeks (mean 16). The post-treatment R-FAS was 3.6. No patient developed a rectal ulcer or fistula. Of the 22 patients who were potent before implantation, 7 (31.8%) maintained potency. With pharmacologic support, 59.1% maintained erections sufficient for vaginal penetration. Day 0 dosimetry demonstrated a median V100 and D90 of 96.5% and 113.5%. At last follow-up, all patients remained free of biochemical failure, with a median prostate-specific antigen level of 0.1 ng/mL.
  
  
  CONCLUSIONS
  No difference in quality-of-life parameters was discerned in patients with grade II and III obesity. In addition, the dosimetric quality of the implants was outstanding, and the short-term biochemical outcome was encouraging.
authors.affiliation: Schiffler Cancer Center, Wheeling Hospital, Wheeling, West Virginia 26003-6300, USA.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Merrick
authors.forename: Wayne M
authors.initials: WM
authors.lastname: Butler
authors.forename: Kent
authors.initials: K
authors.lastname: Wallner
authors.forename: Robert W
authors.initials: RW
authors.lastname: Galbreath
authors.forename: Richard L
authors.initials: RL
authors.lastname: Anderson
authors.forename: Brian S
authors.initials: BS
authors.lastname: Kurko
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Lief
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000532:radiotherapy*; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects*; D007172:Erectile Dysfunction / Q000453:epidemiology / Q000209:etiology; D006304:Health Status; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D010165:Palladium / Q000009:adverse effects / Q000627:therapeutic use; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000532:radiotherapy*; D011788:Quality of Life; D011868:Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use; D011874:Radiometry; D016896:Treatment Outcome; D014570:Urologic Diseases / Q000453:epidemiology / Q000209:etiology
chemical_list: D007457:Iodine Radioisotopes; D011868:Radioisotopes; D010165:Palladium; D017430:Prostate-Specific Antigen