Prophylactic versus therapeutic alpha-blockers after permanent prostate brachytherapy.
OBJECTIVE
To evaluate the influence of prophylactic versus therapeutic alpha-blockers on urinary morbidity after permanent prostate brachytherapy. Multiple clinical and treatment parameters were evaluated to identify the factors associated with acute urinary morbidity.


METHODS
A total of 234 consecutive patients underwent permanent prostate brachytherapy in one of two prospective randomized studies from October 1999 through February 2001 using either palladium-103 or iodine-125 for clinical Stage T1b-T2b (1997 American Joint Commission on Cancer staging system) prostate cancer at either the Schiffler Cancer Center or Puget Sound Health Care System. The mean and median follow-up was 8.8 +/- 4.6 months and 6 months, respectively. In 142 patients, an alpha-blocker was initiated before implantation and continued at least until the International Prostate Symptom Score (IPSS) returned to baseline levels; 92 patients either did not receive an alpha-blocker or received a therapeutic alpha-blocker after implantation because of urinary obstructive symptoms. The clinical and treatment parameters evaluated for urinary morbidity included prophylactic versus therapeutic alpha-blockers, age, preimplant IPSS, ultrasound volume, use of neoadjuvant hormones, use of supplemental external beam radiotherapy, isotope, urethral dose, and multiple dosimetric quality indicators (minimal dose received by 90% of the prostate gland and percentage of prostate volume receiving 100% or 200% of the prescribed minimal peripheral dose). Catheter dependency and the duration of alpha-blocker dependency were also evaluated.


RESULTS
In both the prophylactic and the therapeutic cohorts, the IPSS peaked 1 month after implantation. Patients receiving a prophylactic alpha-blocker returned to baseline at a mean of 4 months and a median of 3 months postoperatively. For those patients not receiving prophylactic alpha-blockers, the IPSS returned to the antecedent value at a mean and median of 10 months and 6 months, respectively. Of the 125 patients receiving prophylactic alpha-blockers, 102 (81.2%) remained medication dependent at the conclusion of the study, and 140 (78.2%) of 179 patients receiving alpha-blockers other than for hypertensive purposes did so. The incidence of prolonged urinary catheter dependency (greater than 3 days) and the need for postimplant transuretheral incision of the prostate/transurethral resection of the prostate were not affected by alpha-blocker use. Cox regression analysis revealed that only the prophylactic use of alpha-blockers and the difference between the preimplant IPSS and the 1-month IPSS were predictive of the time to return to the referent zone.


CONCLUSIONS
Prophylactic use of alpha-blockers results in significantly less urinary morbidity than either the absence or therapeutic use of alpha-blockers. In patients receiving prophylactic alpha-blockers, the IPSS normalized significantly faster but had no impact on urinary retention or the ultimate need for postimplant surgical intervention.
Merrick
Gregory S
GS
Schiffler Cancer Center, Wheeling Hospital, Wheeling, West Virginia 26003-6300, USA.
Butler
Wayne M
WM
Wallner
Kent E
KE
Lief
Jonathan H
JH
Galbreath
Robert W
RW
D000230:Adenocarcinoma / Q000532:radiotherapy*; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D001706:Biopsy; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D017292:Doxazosin / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D010165:Palladium / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy* / Q000517:prevention & control*; D011224:Prazosin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D011868:Radioisotopes / Q000627:therapeutic use; D020266:Radiotherapy, Conformal; D013449:Sulfonamides / Q000627:therapeutic use; D000077409:Tamsulosin; D016896:Treatment Outcome; D016055:Urinary Retention / Q000517:prevention & control; D014555:Urination Disorders / Q000188:drug therapy* / Q000517:prevention & control*
D000317:Adrenergic alpha-Antagonists; D007457:Iodine Radioisotopes; D011868:Radioisotopes; D013449:Sulfonamides; D010165:Palladium; C041226:Terazosin; D017430:Prostate-Specific Antigen; D000077409:Tamsulosin; D017292:Doxazosin; D011224:Prazosin