title: Dysuria Following Stereotactic Body Radiation Therapy for Prostate Cancer.
abstract: BACKGROUND
  Dysuria following prostate radiation therapy is a common toxicity that adversely affects patients' quality of life and may be difficult to manage.
  
  
  METHODS
  Two hundred four patients treated with stereotactic body radiation therapy (SBRT) from 2007 to 2010 for localized prostate carcinoma with a minimum follow-up of 3 years were included in this retrospective review of prospectively collected data. All patients were treated to 35-36.25 Gy in five fractions delivered with robotic SBRT with real time fiducial tracking. Dysuria and other lower urinary tract symptoms were assessed via Question 4b (Pain or burning on urination) of the expanded prostate index composite-26 and the American Urological Association (AUA) Symptom Score at baseline and at routine follow-up.
  
  
  RESULTS
  Two hundred four patients (82 low-, 105 intermediate-, and 17 high-risk according to the D'Amico classification) at a median age of 69 years (range 48-91) received SBRT for their localized prostate cancer with a median follow-up of 47 months. Bother associated with dysuria significantly increased from a baseline of 12% to a maximum of 43% at 1 month (p < 0.0001). There were two distinct peaks of moderate to severe dysuria bother at 1 month and at 6-12 months, with 9% of patients experiencing a late transient dysuria flare. While a low level of dysuria was seen through the first 2 years of follow-up, it returned to below baseline by 2 years (p = 0.91). The median baseline AUA score of 7.5 significantly increased to 11 at 1 month (p < 0.0001) and returned to 7 at 3 months (p = 0.54). Patients with dysuria had a statistically higher AUA score at baseline and at all follow-ups up to 30 months. Dysuria significantly correlated with dose and AUA score on multivariate analysis. Frequency and strain significantly correlated with dysuria on stepwise multivariate analysis.
  
  
  CONCLUSIONS
  The rate and severity of dysuria following SBRT is comparable to patients treated with other radiation modalities.
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA.
authors.forename: Einsley-Marie
authors.initials: EM
authors.lastname: Janowski
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Kole
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA.
authors.forename: Leonard N
authors.initials: LN
authors.lastname: Chen
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA.
authors.forename: Joy S
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Yung
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA.
authors.forename: Brian Timothy
authors.initials: BT
authors.lastname: Collins
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA.
authors.forename: Simeng
authors.initials: S
authors.lastname: Suy
authors.affiliation: Department of Urology, Georgetown University Hospital , Washington, DC , USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Lynch
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA.
authors.forename: Anatoly
authors.initials: A
authors.lastname: Dritschilo
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Collins
keywords: AUA; CyberKnife; dysuria; expanded prostate index composite; prostate cancer; quality of life; stereotactic body radiation therapy