title: Urethral pain among prostate cancer survivors 1 to 14 years after radiation therapy.
abstract: OBJECTIVE
  To investigate how treatment-related and non-treatment-related factors impact urethral pain among long-term prostate cancer survivors.
  
  
  METHODS
  Men treated for prostate cancer with radiation therapy at the Sahlgrenska University Hospital in Göteborg, Sweden from 1993 to 2006 were approached with a study-specific postal questionnaire addressing symptoms after treatment, including urethral burning pain during urination (n=985). The men had received primary or salvage external-beam radiation therapy (EBRT) or EBRT in combination with brachytherapy (BT). Prescribed doses were commonly 70 Gy in 2.0-Gy fractions for primary and salvage EBRT and 50 Gy plus 2×10.0 Gy for EBRT+BT. Prostatic urethral doses were assessed from treatment records. We also recruited 350 non-pelvic-irradiated, population-based controls matched for age and residency to provide symptom background rates.
  
  
  RESULTS
  Of the treated men, 16% (137 of 863) reported urethral pain, compared with 11% (27 of 242) of the controls. The median time to follow-up was 5.2 years (range, 1.1-14.3 years). Prostatic urethral doses were similar to prescription doses for EBRT and 100% to 115% for BT. Fractionation-corrected dose and time to follow-up affected the occurrence of the symptom. For a follow-up≥3 years, 19% of men (52 of 268) within the 70-Gy EBRT+BT group reported pain, compared with 10% of men (23 of 222) treated with 70 Gy primary EBRT (prevalence ratio 1.9; 95% confidence interval 1.2-3.0). Of the men treated with salvage EBRT, 10% (20 of 197) reported urethral pain.
  
  
  CONCLUSIONS
  Survivors treated with EBRT+BT had a higher risk for urethral pain compared with those treated with EBRT. The symptom prevalence decreased with longer time to follow-up. We found a relationship between fractionation-corrected urethral dose and pain. Among long-term prostate cancer survivors, the occurrence of pain was not increased above the background rate for prostatic urethral doses up to 70 Gy3.
authors.affiliation: Department of Physics and Biomedical Engineering, Sahlgrenska University Hospital, and Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden. niclas.pettersson@vgregion.se
authors.forename: Niclas
authors.initials: N
authors.lastname: Pettersson
authors.forename: Caroline
authors.initials: C
authors.lastname: Olsson
authors.forename: Susan L
authors.initials: SL
authors.lastname: Tucker
authors.forename: David
authors.initials: D
authors.lastname: Alsadius
authors.forename: Ulrica
authors.initials: U
authors.lastname: Wilderäng
authors.forename: Karl-Axel
authors.initials: KA
authors.lastname: Johansson
authors.forename: Gunnar
authors.initials: G
authors.lastname: Steineck
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D011471:Prostatic Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D011829:Radiation Dosage; D011878:Radiotherapy / Q000009:adverse effects; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods; D011795:Surveys and Questionnaires; D017741:Survivors; D013997:Time Factors; D014521:Urethra / Q000528:radiation effects*; D014522:Urethral Diseases / Q000453:epidemiology / Q000209:etiology*; D014554:Urination / Q000502:physiology