title: Decline in acute urinary toxicity: a long-term study in 2011 patients with prostate brachytherapy within a provincial institution.
abstract: OBJECTIVE
  To determine whether acute urinary toxicity rates improve with the overall experience of a large prostate brachytherapy program.
  
  
  METHODS
  From 1998 to 2009, 2937 patients were treated with prostate brachytherapy at the British Columbia Cancer Agency. Baseline patient, treatment, and implant factors were recorded prospectively. Acute urinary toxicity data were prospectively recorded at baseline and each follow-up visit. Patients with ≥2 years of follow-up data were grouped into cohorts of 500 for analysis.
  
  
  RESULTS
  Two thousand eleven patients met the above criteria. Acute urinary retention (AUR) in the acute period (within 6 months of implant) occurred in 9.1% of patients overall and was prolonged (catheterization >20 days) in 3.4%. Both overall AUR and prolonged AUR decreased across implant cohorts (p ≤ 0.001 in both cases). Overall acute Radiation Therapy Oncology Group (RTOG) Grades 0 and 1 urinary toxicity rate was 57.5% and RTOG Grades 2 and 3 urinary toxicity rates were 34.3% and 8.1%, respectively. Acute toxicity improved over time for both RTOG Grades ≥2 and ≥3 toxicity (p < 0.0001). International prostate symptom score resolution to baseline was achieved in 80.5% of patients with a median time of 12.2 months.
  
  
  CONCLUSIONS
  Acute AUR and RTOG urinary toxicity rates continue to decline with the increasing experience of our provincial prostate brachytherapy program, despite its expansion to new centers and addition of members. This is likely due to better patient selection, refinement in treatment planning and implantation technique, and mentorship and training process.
authors.affiliation: Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Elisa K
authors.initials: EK
authors.lastname: Chan
authors.affiliation: Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada. Electronic address: mkeyes@bccancer.bc.ca.
authors.forename: Mira
authors.initials: M
authors.lastname: Keyes
authors.affiliation: Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Tom
authors.initials: T
authors.lastname: Pickles
authors.affiliation: Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lapointe
authors.affiliation: Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Spadinger
authors.affiliation: Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: McKenzie
authors.affiliation: Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: W James
authors.initials: WJ
authors.lastname: Morris
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000150:complications / Q000532:radiotherapy*; D013997:Time Factors; D001743:Urinary Bladder / Q000528:radiation effects*; D016055:Urinary Retention / Q000209:etiology*
keywords: Acute urinary toxicity; Learning curve; Prostate brachytherapy