Prediction of genitourinary tract morbidity after brachytherapy for prostate adenocarcinoma.
OBJECTIVE
To investigate whether preoperative genitourinary variables in patients undergoing brachytherapy for localized prostate adenocarcinoma could predict postoperative genitourinary tract morbidity.


METHODS
We retrospectively reviewed medical records of 105 men who received either iodine 125 or palladium 103 radioactive seed implants with or without external beam radiotherapy or hormone blockade from January 1, 1998, through December 31, 2000, at the Mayo Clinic in Jacksonville, Fla. Patients with one or more of the following were classified as having a high risk of postoperative genitourinary tract morbidity: American Urological Association symptom scores greater than 15, maximum urinary flow rate less than 10 mL/s, postvoid residual urinary volume greater than 100 mL, or prostate volume greater than 40 cm3. Of the 105 men, 59 (56%) were classified as high risk and 46 (44%) as low risk. Mean follow-up after brachytherapy was 23.6 months. Modified Radiation Therapy Oncology Group scores were used to assess postoperative genitourinary tract morbidity. The term significant genitourinary tract morbidity was applied to patients with a Radiation Therapy Oncology Group grade of 3 or 4 after at least 6 months of follow-up.


RESULTS
Significant morbidity occurred in 37% of high-risk vs 15% of low-risk patients (P = .006). In high-risk patients, transurethral resection or incision of the prostate was required in 5 patients, urethral dilation in 4, direct-vision internal urethrotomy in 1, and placement of a suprapubic catheter in 1. In low-risk patients, transurethral incision of the prostate was required in only 1 patient. Urinary flow rate was a significant individual predictor of postoperative morbidity (P = .03).


CONCLUSIONS
A combination of urinary flow rate, prostate volume, postvoid residual urinary volume, and American Urological Association symptom score can help identify patients with underlying voiding dysfunction. Urinary flow rate was a statistically significant predictor of genitourinary tract morbidity after brachytherapy for localized prostate adenocarcinoma. Patients and physicians should consider these factors before a patient decides to undergo brachytherapy.
Department of Urology, Mayo Clinic, College of Medicine, Jacksonville, Fla 32224, USA. wehle.michael@mayo.edu
Michael J
MJ
Wehle
Scott W
SW
Lisson
Steven J
SJ
Buskirk
Gregory A
GA
Broderick
Paul R
PR
Young
Todd C
TC
Igel
D000230:Adenocarcinoma / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects*; D004106:Dilatation; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D010165:Palladium / Q000627:therapeutic use; D011471:Prostatic Neoplasms / Q000503:physiopathology / Q000628:therapy*; D011868:Radioisotopes / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D020728:Transurethral Resection of Prostate / Q000009:adverse effects; D014525:Urethral Stricture / Q000628:therapy; D014546:Urinary Catheterization / Q000009:adverse effects; D014549:Urinary Incontinence / Q000209:etiology; D014563:Urodynamics / Q000502:physiology
D000726:Androgen Antagonists; D007457:Iodine Radioisotopes; D011868:Radioisotopes; D010165:Palladium