Is hormone therapy a protective factor for late hematuria after high-dose radiotherapy in prostate cancer?
OBJECTIVE
To identify potential clinical and dosimetric factors predictive of a higher risk of grade 2 or higher late hematuria in patients with prostate cancer treated with high-dose radiotherapy.


METHODS
For this purpose, we have analyzed 229 T1c-T3b prostate cancer patients treated with 3-dimensional conformal radiotherapy (3DCRT) in a prospective dose escalation study and with a minimum follow-up of 1 year. The mean radiation dose was 79 Gy (range 72.1 to 84.14 Gy) and the mean follow-up was 47 months (range 14 to 95). One hundred eighteen patients also received androgen deprivation (AD) for high-risk disease. Univariate and multivariate analysis (MVA) were performed to identify variables significantly associated with late hematuria.


RESULTS
Of the 31 (14%) patients with grade 2 or higher genitourinary toxicity, hematuria was the main symptom in 24 (10.5%) with only 1 patient (0.5%) experiencing grade 3 hematuria. On statistical analysis, all the dosimetric parameters failed to show a significant correlation with grade 2 or higher hematuria. On MVA, prior transurethral resection of the prostate (TURP) was significantly associated with a higher risk of late hematuria (relative risk [RR] = 2.8; P = 0.026), whereas long-term AD was correlated with a significantly decreased risk (RR = 0.21; P = 0.019).


CONCLUSIONS
TURP was a relevant factor increasing 3 times the risk of late hematuria in prostate cancer patients treated with 3DCRT. Conversely, long-term AD resulted in a protective factor decreasing 5 times the risk of late hematuria. To our knowledge, this is the first study reporting a protecting effect of long-term hormones in late toxicity after radiotherapy.
Zapatero
Almudena
A
Department of Radiation Oncology, Hospital Universitario de la Princesa, Madrid, Spain. azapatero.hlpr@salud.madrid.org
García-Vicente
Feliciano
F
Sevillano
David
D
Martín de Vidales
Carmen
C
Ferrer
Carlos
C
Torres
Juan José
JJ
Minguez
Ricardo
R
Rabadán
Mariano
M
D000368:Aged; D000726:Androgen Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D006417:Hematuria / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors
D000726:Androgen Antagonists