title: Chronic pelvic pain following prostate brachytherapy: a case report.
abstract: OBJECTIVE
  To alert physicians and potential patients that chronic postimplant pelvic pain syndromes can occur, and that dosimetric parameters (i.e., implant technique) may predispose patients to it.
  
  
  METHODS
  The authors are currently following 3 prostate brachytherapy patients with what appear to be chronic radiation-related pelvic pain, variously exacerbated by urination or perineal pressure. The 3 patients were identified in the course of routine follow-up, and do not represent a concerted attempt to identify such patients from a larger group of patients being followed by the authors. Three control groups of 10 patients each treated with (125)I, (103)Pd, or (103)Pd + external beam radiation and with no reported dysuria at 6 months postimplant were taken from two ongoing prospective trials. The 3 patients reported here were each administered a brief questionnaire regarding the effect of their urinary pain on daily activities.
  
  
  RESULTS
  Patients with chronic pain tended to have high central prostatic doses, at least on some planes. Maximal, mean, and median urethral doses were higher for patients with chronic pain, but there was some overlap with control patients. The prostate V100s were similar between patients with chronic pain and controls, but there was a trend toward higher V200s and V300s in pain syndrome patients.
  
  
  CONCLUSIONS
  Recalcitrant brachytherapy-related pelvic pain is an uncommon occurrence that may be partly related to higher central prostatic doses.
authors.affiliation: Radiation Oncology(#174), Department of Veterans Affairs, 1660 S. Columbian Way, Seattle, WA 98108-1597, USA. kent.wallner@med.gov.va
authors.forename: Kent
authors.initials: K
authors.lastname: Wallner
authors.forename: Kathryn
authors.initials: K
authors.lastname: Elliott
authors.forename: Gregory
authors.initials: G
authors.lastname: Merrick
authors.forename: Maged
authors.initials: M
authors.lastname: Ghaly
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Maki
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects*; D002908:Chronic Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D017699:Pelvic Pain / Q000209:etiology*; D011471:Prostatic Neoplasms / Q000532:radiotherapy