Findings at cystoscopy performed for cause after prostate brachytherapy.
OBJECTIVE
To characterize cystoscopy findings performed for cause after prostate brachytherapy in men.


METHODS
A retrospective review of cystoscopy reports in 2532 men treated with prostate brachytherapy with or without external beam radiation therapy for clinically localized prostate cancer between 1990 and 2011 was performed. We investigated the relationship between relevant clinical and demographic characteristics with the development of particular cystoscopic findings in patients with hematuria or lower urinary tract symptoms.


RESULTS
One hundred eighty-five of 2532 men (7.3%) underwent cystoscopy for gross or microscopic hematuria or refractory urinary symptoms at a median time of 2.7 years after implantation and were followed up for a median of 5.9 years after treatment. Most had a negative cystoscopy finding, whereas in 67 of 185 (36.2%), the findings included bladder tumors in 18 (27%), hypervascularity in 18 (27%), radiation cystitis in 13 (19.4%), inflammation in 7 (10.4%), urethral stricture in 5 (7.5%), and calculus disease in 6 (8.9%). Cystoscopic findings did not significantly differ when stratified by cystoscopy indication (P=.515). Bladder tumors were identified in similar proportions among men with gross hematuria (9.6%) and refractory urinary symptoms (10.3%, P=.840).


CONCLUSIONS
Cystoscopy after brachytherapy performed for cause demonstrates a relatively low incidence of benign and malignant pathologies. Detection of bladder tumors was uncommon, although equally observed among men with hematuria and urinary symptoms. Low threshold to perform cystoscopy should be considered in men with hematuria or persistent lower urinary tract symptoms after prostate brachytherapy.
Deane Prostate Health and Research Center, Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
Michael S
MS
Leapman
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY.
Richard G
RG
Stock
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY.
Nelson N
NN
Stone
Deane Prostate Health and Research Center, Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: simon.hall@mountsinai.org.
Simon J
SJ
Hall
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D003558:Cystoscopy / Q000379:methods*; D006417:Hematuria / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D016017:Odds Ratio; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment