title: Do high radiation doses in locally advanced prostate cancer patients treated with 103Pd implant plus external beam irradiation cause increased urinary, rectal, and sexual morbidity?
abstract: OBJECTIVE
  To investigate the morbidity of higher radiation doses in prostate cancer patients.
  
  
  METHODS
  Five hundred eighty-five men treated with seed implantation and external beam irradiation were followed a median of 5 years (range, 2-11). Hormonal therapy (HT) of 9 months duration was used in 504 (86.2%) patients. The biologic effective dose (BED) was calculated using an alpha/beta of 2. Urinary incontinence (UI) and symptoms (IPSS) were prospectively collected. Rectal morbidity was scored according to the Radiation Therapy Oncology Group (RTOG) scale. Two BED dose groups of <or=220 Gy (n=449) and >220 Gy (n=136) were used. Comparisons of means were made by Student's t test, and the associations were tested by chi-square analysis (Pearson).
  
  
  RESULTS
  Urinary retention developed in 36 (6.2%) and was not associated with BED or IPSS. Retention occurred more often with prostate volume >50 cc (17%, p=0.001). The median change in urinary symptoms (IPSS) was 1. Sixty-one percent with high BED were more likely to have increased postimplant symptoms compared with 39% with lower BED (p=0.025; odds ratio [OR], 1.107; 95% confidence interval [CI], 1.10-1.21). UI occurred in 25 patients (4.3%) and was only associated with a postimplant transurethral resection of the prostate (TURP) (n=25), 16% vs. 2.3% for no TURP (p=0.001; OR, 8; 95% CI, 2.4-27). Of the 373 patients initially potent, 204 (54.7%) maintained potency. Impotence was only associated with age at implant (p=0.001) and HT (p=0.004). Sixty-two (10.6%) patients had Grade 1-2 and 4 patients had Grade 3-4 (0.7%, 2 ulcers and 2 fistulas) rectal complications. Three of the Grade 3/4 complications occurred with a dose <or=220 Gy.
  
  
  CONCLUSIONS
  A BED >220 Gy does not seem to increase morbidity.
authors.affiliation: Department of Urology, Mount Sinai School of Medicine, New York, NY 10075, USA. nelsonstone@optonline.net
authors.forename: Nelson N
authors.initials: NN
authors.lastname: Stone
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Cesaretti
authors.forename: Barry
authors.initials: B
authors.lastname: Rosenstein
authors.forename: Richard G
authors.initials: RG
authors.lastname: Stock
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000706:statistics & numerical data; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D015897:Comorbidity; D004307:Dose-Response Relationship, Radiation; D007172:Erectile Dysfunction / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010165:Palladium / Q000627:therapeutic use*; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000453:epidemiology*; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000706:statistics & numerical data; D012002:Rectal Diseases / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D014555:Urination Disorders / Q000453:epidemiology*
chemical_list: D019275:Radiopharmaceuticals; D010165:Palladium