title: Hematuria following stereotactic body radiation therapy (SBRT) for clinically localized prostate cancer.
abstract: BACKGROUND
  Hematuria following prostate radiotherapy is a known toxicity that may adversely affect a patient's quality of life. Given the higher dose of radiation per fraction using stereotactic body radiation therapy (SBRT) there is concern that post-SBRT hematuria would be more common than with alternative radiation therapy approaches. Herein, we describe the incidence and severity of hematuria following stereotactic body radiation therapy (SBRT) for prostate cancer at our institution.
  
  
  METHODS
  Two hundred and eight consecutive patients with prostate cancer treated with SBRT monotherapy with at least three years of follow-up were included in this retrospective analysis. Treatment was delivered using the CyberKnife® (Accuray) to doses of 35-36.25 Gy in 5 fractions. Toxicities were scored using the CTCAE v.4. Hematuria was counted at the highest grade it occurred in the acute and late setting for each patient. Cystoscopy findings were retrospectively reviewed. Univariate and multivariate analyses were performed. Hematuria-associated bother was assessed via the Expanded Prostate Index Composite (EPIC)-26.
  
  
  RESULTS
  The median age was 69 years with a median prostate volume of 39 cc. With a median follow-up of 48 months, 38 patients (18.3%) experienced at least one episode of hematuria. Median time to hematuria was 13.5 months. In the late period, there were three grade 3 events and five grade 2 events. There were no grade 4 or 5 events. The 3-year actuarial incidence of late hematuria ≥ grade 2 was 2.4%. On univariate analysis, prostate volume (p = 0.022) and history of prior procedure(s) for benign prostatic hypertrophy (BPH) (p = 0.002) were significantly associated with hematuria. On multivariate analysis, history of prior procedure(s) for BPH (p < 0.0001) and α1A antagonist use (p = 0.008) were significantly associated with the development of hematuria.
  
  
  CONCLUSIONS
  SBRT for prostate cancer was well tolerated with hematuria rates comparable to other radiation modalities. Patients factors associated with BPH, such as larger prostate volume, alpha antagonist usage, and prior history of procedures for BPH are at increased risk for the development of hematuria.
authors.affiliation: Department of Radiation Oncology, University of Louisville, Louisville, USA. marie.gurka@gmail.com.
authors.forename: Marie K
authors.initials: MK
authors.lastname: Gurka
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C, 20007, USA. leonard.n.chen@gunet.georgetown.edu.
authors.forename: Leonard N
authors.initials: LN
authors.lastname: Chen
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C, 20007, USA. abhagat@gwmail.gwu.edu.
authors.forename: Aditi
authors.initials: A
authors.lastname: Bhagat
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C, 20007, USA. Rudy.A.Moures@gunet.georgetown.edu.
authors.forename: Rudy
authors.initials: R
authors.lastname: Moures
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C, 20007, USA. jsk64@georgetown.edu.
authors.forename: Joy S
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C, 20007, USA. Thomas.M.Yung@gunet.georgetown.edu.
authors.forename: Thomas
authors.initials: T
authors.lastname: Yung
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C, 20007, USA. siyuan.lei@gunet.georgetown.edu.
authors.forename: Siyuan
authors.initials: S
authors.lastname: Lei
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C, 20007, USA. collinsbt@georgetown.edu.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Collins
authors.affiliation: Department of Radiology, Georgetown University Hospital, Washington, USA. pk323@georgetown.edu.
authors.forename: Pranay
authors.initials: P
authors.lastname: Krishnan
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C, 20007, USA. suys@georgetown.edu.
authors.forename: Simeng
authors.initials: S
authors.lastname: Suy
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C, 20007, USA. dritscha@gunet.georgetown.edu.
authors.forename: Anatoly
authors.initials: A
authors.lastname: Dritschilo
authors.affiliation: Department of Urology, Georgetown University Hospital, Washington, USA. lynchj@georgetown.edu.
authors.forename: John H
authors.initials: JH
authors.lastname: Lynch
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C, 20007, USA. SPC9@georgetown.edu.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Collins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006417:Hematuria / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011470:Prostatic Hyperplasia / Q000473:pathology / Q000601:surgery*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011788:Quality of Life; D016634:Radiosurgery / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies