Urinary symptom flare in 712 125I prostate brachytherapy patients: long-term follow-up.
OBJECTIVE
To describe the late transient worsening of urinary symptoms ("urinary symptom flare") in 712 consecutive prostate brachytherapy patients, associated predictive factors, association with rectal and urinary toxicity, and the development of erectile dysfunction.


METHODS
Patients underwent implantation between 1998 and 2003 (median follow-up, 57 months). International Prostate Symptom Score (IPSS), Radiation Therapy Oncology Group (RTOG) toxicity, and erectile function data were prospectively collected. Flare was defined as an increase in IPSS of > or =5 and of > or =8 points greater than the post-treatment nadir. The relationships between the occurrence of flare and the patient, tumor, and treatment characteristics were examined. The Cox proportional hazards method was used to test individual variables and the multivariate models.


RESULTS
The incidence of flare was 52% and 30% using the flare definition of an IPSS of > or =5 and > or =8 points greater than the postimplant nadir, respectively. Of the patients with symptoms, 65% had resolution of their symptoms within 6 months and 91% within 1 year. Flares most commonly occurred 16-24 months after implantation. On multivariate analysis, a greater baseline IPSS and greater maximal postimplant IPSS were the predictors of flare, regardless of the flare definition used. Androgen suppression was a predictor for fewer flares (IPSS > or =5). Diabetes and prostate edema predicted for more frequent flares (IPSS >/=8). Patients with flare had a greater incidence of RTOG Grade 3 urinary toxicity and RTOG Grade 2 or greater rectal toxicity. No association was found between erectile dysfunction and the occurrence of flare.


CONCLUSIONS
Urinary symptom flare is a common, transient phenomenon after prostate brachytherapy. A greater baseline IPSS and maximal postimplant IPSS were the strongest predictive factors. Flare was associated with a greater incidence of late RTOG Grade 3 urinary toxicity and greater rate of late RTOG Grade 2 or greater rectal toxicity.
Keyes
Mira
M
Department of Surgery, University of British Columbia, Provincial Prostate Brachytherapy Program, British Columbia Cancer Agency, 600 W. 10th Avenue, Vancouver, BC, Canada. mkeyes@bccancer.bc.ca
Miller
Stacy
S
Moravan
Veronika
V
Pickles
Tom
T
Liu
Mitchell
M
Spadinger
Ingrid
I
Lapointe
Vincent
V
Morris
W James
WJ
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000727:Androgen-Binding Protein / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects*; D007172:Erectile Dysfunction / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D012007:Rectum / Q000528:radiation effects; D014555:Urination Disorders / Q000209:etiology*
D000727:Androgen-Binding Protein; D007457:Iodine Radioisotopes; D017430:Prostate-Specific Antigen