title: The effect of hormonal manipulation on urinary function following permanent prostate brachytherapy.
abstract: OBJECTIVE
  To evaluate the effect of hormonal manipulation on catheter dependency, the resolution of urinary symptomatology, and the need for postbrachytherapy transurethral/transincisional resection (TURP/TUIP).
  
  
  METHODS
  Seven hundred sixteen consecutive patients (median follow-up, 29 months) underwent brachytherapy for clinical T1b-T3a (1997 AJCC) prostate cancer from January 1998 through August 2002. Of the evaluated cohort, 400 patients were hormone naïve, 227 received short-course cytoreductive (< or = 6 months) hormonal therapy, and 89 received extended (>6 months) hormonal therapy. An alpha-blocker was initiated prior to implantation and continued at least until the International Prostate Symptom Score (I-PSS) returned to baseline levels. Evaluated parameters included age, T-stage, preimplant I-PSS, ultrasound volume, treatment planning volume, hormonal status, supplemental external beam radiation therapy (XRT), isotope, urethral dose, total implant activity, D90, and V100/150/200. Catheter dependency and the incidence of TURP/TUIP were also evaluated.
  
  
  RESULTS
  Six hundred fifty three patients (91.2%) had the urinary catheter permanently removed on day 0 with 15 patients (2.1%) requiring a catheter beyond 4 days. The I-PSS returned to within 1 point of the antecedent value at a median of 4 months. Sixteen patients (2.2%) underwent postimplant TURP/TUIP. A Cox regression indicated that preimplant I-PSS, supplemental XRT, planning target volume, hormonal therapy, and number of seeds were the strongest predictors for I-PSS resolution. Using all available data, the strongest predictors for I-PSS at 18 months following brachytherapy included variants of I-PSS, isotope, and days of catheter dependency. The maximum I-PSS, planning target volume, and XRT best predicted for prolonged (#10878;4 days) catheter dependency. The need for postimplant TURP/TUIP was most closely associated with days of catheter dependency and the maximum increase in I-PSS. However, when only data available prior to implantation was entered into the model, hormonal therapy predicted for postsurgical intervention.
  
  
  CONCLUSIONS
  In this retrospective evaluation, hormonal manipulation did not statistically impact short-term or prolonged urinary catheter dependency or I-PSS at 18 months, but did influence time to I-PSS normalization and the need for postbrachytherapy surgical intervention.
authors.affiliation: Schiffler Cancer Center, Wheeling Hospital, Wheeling, WV 26003-6300, USA. gmerrick@wheelinghospital.com
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Merrick
authors.forename: Wayne M
authors.initials: WM
authors.lastname: Butler
authors.forename: Kent E
authors.initials: KE
authors.lastname: Wallner
authors.forename: Brian
authors.initials: B
authors.lastname: Murray
authors.forename: Zachariah
authors.initials: Z
authors.lastname: Allen
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Lief
authors.forename: Robert W
authors.initials: RW
authors.lastname: Galbreath
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D001918:Brachytherapy / Q000009:adverse effects*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D010165:Palladium; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery; D011868:Radioisotopes; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate; D014546:Urinary Catheterization; D016055:Urinary Retention / Q000209:etiology* / Q000517:prevention & control*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D007457:Iodine Radioisotopes; D011868:Radioisotopes; D010165:Palladium