Predictive factors of acute urinary morbidity after iodine-125 brachytherapy for localised prostate cancer: a phase 2 study.
OBJECTIVE
To analyse predictive factors of acute urinary morbidity after transperineal permanent prostate brachytherapy.


METHODS
Sixty patients treated in a phase 2 study with iodine-125 brachytherapy (9/1998 to 2/2000) for localised prostate adenocarcinoma were analysed after at least 1-year follow-up. Prescribed dose was 144 Gy and all patients had a pre-planning and a post-implant dosimetry. Urinary morbidity was evaluated prospectively using the Radiation Therapy Oncology Group (RTOG) scale. We examined the relationship between pre-implant ultrasound prostate volume, post-implant CT-scan prostate volume, neoadjuvant hormonotherapy, total number of needles and seeds, post-implant dosimetry variables, first 30 vs. last 30 treated patients and post-implant urinary morbidity.


RESULTS
All patients experienced some degree of urinary distress symptoms after treatment. Symptoms were generally mild grade 1 in 56% and grade 2 in 10% lasting less than 6 months. Eight patients (13%) required bladder catheter for acute urinary obstruction. At 1-year follow-up, nine patients (15%) complained from persistent dysuria requiring in three cases endoscopic prostate resection. The percentage of urethra volume receiving 216 Gy (cut-off 40%) and the pre-implant prostate volume (cut-off 31 ml) were the only statistically significant predictor of grade 2-3 or persistent urinary morbidity on multivariate analysis.


CONCLUSIONS
Our short-term data suggest that both pre-implant prostate volume value and post-implant V.U. 150 value might be predictors for urinary morbidity after prostate brachytherapy.
Salem
Naji
N
Departments of Radiotherapy and Medical Physics, Institut Paoli Calmettes, Marseilles, France.
Simonian-Sauve
Michelle
M
Rosello
Roland
R
Alzieu
Claude
C
Gravis
Gwenaelle
G
Maraninchi
Dominique
D
Bladou
Franck
F
D000230:Adenocarcinoma / Q000532:radiotherapy*; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011829:Radiation Dosage; D016896:Treatment Outcome; D016055:Urinary Retention / Q000209:etiology*; D014555:Urination Disorders / Q000209:etiology
D007457:Iodine Radioisotopes