title: Segmental urethral dosimetry and urinary toxicity in patients with no urinary symptoms before permanent prostate brachytherapy.
abstract: OBJECTIVE
  To determine whether segmental urethral dosimetry is predictive for the degree of urinary morbidity after prostate brachytherapy in patients with no urinary symptoms before prostate brachytherapy.
  
  
  METHODS
  Between May 2000 and November 2005, 1,107 patients underwent iodine-125 monotherapy with urethral sparing techniques. A total of 166 patients fulfilled the selection criteria: baseline (International Prostate Symptom Score) IPSS < or =5, no androgen deprivation therapy, and prostate ultrasound planning volumes (PUTV) <45 mL. The median follow-up was 44 months. Urinary morbidity was defined by maximum increase in IPSS, time to IPSS resolution, maximum Radiation Therapy Oncology Group (RTOG) score, time to RTOG resolution, and urinary retention. Surrogate deviated urethra was contoured and doses calculated at the base, mid-prostate, apex, and urogenital diaphragm. Univariate and multivariate analysis was used to evaluate urethral and prostate dosimetry, age, PUTV, and number of needles for their association with urinary morbidity.
  
  
  RESULTS
  Urethral dose was fairly constant in all urethra segments except prostate base, where the variation in does was large. On multivariate analysis, higher urethral base D50, V100, and larger PUTV were predictive for higher maximum increase in IPSS. Higher urethral base V100 and larger PUTV predicted for prolonged IPSS resolution. Higher urethral base D50 and larger needle number predicted for longer RTOG resolution. Higher urethral base V100 predicted for RTOG > or =2 toxicity.
  
  
  CONCLUSIONS
  Radiation dose to the urethral base, larger PUTV, and needle number, predicted for increased urinary toxicity after prostate brachytherapy. Correlation between urinary morbidity and urethral base dosimetry may reflect a large variation in urethral dose observed at the prostate base.
authors.affiliation: Department of Radiation Oncology, Vancouver Cancer Centre, Vancouver, BC, Canada.
authors.forename: Carys
authors.initials: C
authors.lastname: Thomas
authors.forename: Mira
authors.initials: M
authors.lastname: Keyes
authors.forename: Mitchell
authors.initials: M
authors.lastname: Liu
authors.forename: Veronika
authors.initials: V
authors.lastname: Moravan
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000528:radiation effects; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D014463:Ultrasonography; D014521:Urethra / Q000000981:diagnostic imaging / Q000528:radiation effects*; D014524:Urethral Obstruction / Q000209:etiology* / Q000628:therapy; D014546:Urinary Catheterization
chemical_list: D007457:Iodine Radioisotopes