title: External beam radiotherapy for prostate cancer: urinary outcomes for men with high International Prostate Symptom Scores (IPSS).
abstract: OBJECTIVE
  To report the urinary outcome of men treated for prostate cancer with external beam radiotherapy (EBRT) who have pretreatment obstructive urinary symptoms (International Prostate Symptom Score [IPSS] ≥ 15).
  
  
  METHODS
  We treated 368 patients with EBRT for localized prostate cancer, and pre- and post-radiotherapy (RT) IPSSs were recorded. In total, 80 men had an IPSS ≥ 15, 48% of whom were taking genitourinary (GU) medications before RT. The IPSS was followed over time and analyzed as a pretreatment factor against Radiation Therapy Oncology Group acute and late GU toxicity.
  
  
  RESULTS
  The median follow-up was 44 months. Among men with a pre-RT IPSS ≥ 15, the median IPSS at baseline, first follow-up, and last follow-up was 18 (range, 15 to 34), 17 (range, 0 to 32), and 13 (range, 0 to 34), respectively. The mean patient declines in IPSS from baseline to first and last follow-up were -3.6 points (p < 0.0004) and -6.9 points (p < 0.0001), respectively. At last follow-up, 43 men (54%) took GU medications. Pre-RT IPSS ≥ 15 vs. ≤ 14 was associated with a higher incidence of Grade ≥ 2 acute GU toxicity (64% vs. 42%, p = 0.0005), and 4-year freedom from Grade ≥ 2 late GU toxicity was 38% vs. 64% (p < 0.0001). There was no greatly increased risk of Grade ≥ 3 late GU toxicity for men with IPSS ≥ 15 (4-year freedom from Grade ≥ 3 late GU toxicity of 90% vs. 96%, p = 0.0964).
  
  
  CONCLUSIONS
  Although the improvement is not immediate, men with moderate to severe obstructive GU symptoms can have improvement in urinary function after EBRT, without significant risk for severe morbidity.
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL 60637, USA.
authors.forename: Renuka
authors.initials: R
authors.lastname: Malik
authors.forename: Ashesh B
authors.initials: AB
authors.lastname: Jani
authors.forename: Stanley L
authors.initials: SL
authors.lastname: Liauw
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D053448:Prostatism / Q000150:complications / Q000532:radiotherapy*; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016055:Urinary Retention / Q000209:etiology; D014555:Urination Disorders / Q000209:etiology*