(125)Iodine prostate brachytherapy: outcome from the first 100 consecutive patients and selection strategies incorporating urodynamics.
OBJECTIVE
To report the results from the first 100 consecutive patients treated with 125I transperineal interstitial prostate brachytherapy between March 1999 and June 2001, and to determine if the International Prostate Symptom Score (IPSS), prostate volume or urodynamic variables correlate with acute morbidity.


METHODS
Patients were assessed prospectively by uroflowmetry, the IPSS, a physical examination and transrectal ultrasonography. Of the 100 patients, 57 had a full urodynamic assessment, 61 presented with lower urinary tract symptoms (LUTS), 25 were screen-detected and 14 presented with other problems. The IPSS was recorded at 1, 6 and 12 weeks, and then at 3-monthly intervals after treatment; significant events, e.g. acute urinary retention (AUR) and rectal symptoms, were recorded prospectively; the mean follow-up was 16 months.


RESULTS
No patients were incontinent after treatment. There was a temporary deterioration in IPSS in 89% of patients. Peak symptoms occurred at 6 weeks and a statistically significant deterioration in IPSS persisted until 9 months, but continued to improve throughout the follow-up. AUR affected seven patients, with a further 20 using clean intermittent self-catheterization (CISC) for symptoms. In most patients the symptoms resolved spontaneously to the levels before treatment, with only two patients requiring surgery for bladder outlet obstruction. The IPSS before treatment did not predict urodynamic obstruction. Urodynamically unobstructed patients did not require catheterization. By 2 years after implantation the mean IPSS was better than before treatment. Five patients had mild, transient proctitis.


CONCLUSIONS
Selecting patients with a low prostate volume and IPSS is likely to optimize the outcome of brachytherapy. Urodynamic studies may be helpful in predicting the risk of AUR and symptoms requiring CISC. Despite many patients presenting with LUTS, acute morbidity was no worse than that reported in large American series of predominantly screening-detected cancers. Prostate brachytherapy is well tolerated and may be safely delivered to patients with prostate cancer in the UK.
Henderson
A
A
St. Luke's Cancer Centre, Guildford, Surrey, UK. AliHenderson@Freenet.co.uk
Cahill
D
D
Laing
R W
RW
Langley
S E M
SE
D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D012044:Regression Analysis; D012307:Risk Factors; D012648:Self Care / Q000379:methods; D016896:Treatment Outcome; D014546:Urinary Catheterization / Q000379:methods; D014563:Urodynamics / Q000528:radiation effects*
D007457:Iodine Radioisotopes