title: Patient- and treatment-specific predictors of genitourinary function after high-dose-rate monotherapy for favorable prostate cancer.
abstract: OBJECTIVE
  High-dose-rate (HDR) brachytherapy alone is an effective treatment option for patients with early-stage prostate cancer. The purpose of this study was to quantify patient-reported short- and long-term toxicity and quality of life (QOL) after HDR monotherapy.
  
  
  METHODS
  Thirty-nine consecutive men between May 2001 and January 2012 were identified for this analysis. All patients underwent definitive HDR monotherapy for favorable prostate cancer to a total dose of 3150 cGy in three fractions, 3800 cGy in four fractions, or 3850 in five fractions. Patient-reported genitourinary function was assessed before HDR, during an acute period after treatment (within 90 days of HDR), and on long-term followup using the American Urological Association International Prostate Symptom Score, a urinary QOL Likert questionnaire, and the Sexual Health Inventory for Men questionnaire. Regression analyses were performed using the ordinary least squares method.
  
  
  RESULTS
  With median followup of 57 months, biochemical progression-free survival was 100%. There were no grade ≥3 toxicities. Dose to the urethra and bladder, as well as prostate size and intraprostatic urethra length were predictive for short-term changes in QOL. Advanced patient age was predictive for worse sexual function on both acute and long-term followup.
  
  
  CONCLUSIONS
  Toxicity after HDR monotherapy for prostate cancer is acceptable. Patients with larger prostates, longer intraprostatic urethras, and greater doses to the bladder and urethra may experience worse acute urinary QOL. Older patients may experience greater impairment in sexual function in the short and long terms.
authors.affiliation: Department of Radiation Oncology, University of California San Francisco, San Francisco, CA.
authors.forename: David R
authors.initials: DR
authors.lastname: Raleigh
authors.affiliation: Department of Radiation Oncology, University of California San Francisco, San Francisco, CA.
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Chang
authors.affiliation: Department of Economics, California State University Chanel Islands, Camarillo, CA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Tomlin
authors.affiliation: Department of Economics, California State University Chanel Islands, Camarillo, CA.
authors.forename: J Adam
authors.initials: JA
authors.lastname: Cunha
authors.affiliation: Department of Radiation Oncology, University of California San Francisco, San Francisco, CA.
authors.forename: Steve E
authors.initials: SE
authors.lastname: Braunstein
authors.affiliation: Department of Urology, University of California San Francisco, San Francisco, CA.
authors.forename: Katsuto
authors.initials: K
authors.lastname: Shinohara
authors.affiliation: Department of Radiation Oncology, University of California San Francisco, San Francisco, CA.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Gottschalk
authors.affiliation: Department of Radiation Oncology, University of California San Francisco, San Francisco, CA; Department of Urology, University of California San Francisco, San Francisco, CA.
authors.forename: Mack
authors.initials: M
authors.lastname: Roach
authors.affiliation: Department of Radiation Oncology, University of California San Francisco, San Francisco, CA. Electronic address: IHsu@radonc.ucsf.edu.
authors.forename: I-Chow
authors.initials: IC
authors.lastname: Hsu
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods*; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011788:Quality of Life; D011829:Radiation Dosage; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D011795:Surveys and Questionnaires; D014521:Urethra / Q000473:pathology*; D001743:Urinary Bladder; D014566:Urogenital System / Q000503:physiopathology* / Q000528:radiation effects
chemical_list: D017430:Prostate-Specific Antigen
keywords: Brachytherapy; High-dose-rate; Prostate cancer; Quality of life; Side effects; Toxicity