Dysuria after permanent prostate brachytherapy.

Abstract

PURPOSE: Although numerous prostate cancer quality-of-life studies have been reported, a paucity of data exists regarding brachytherapy-related dysuria. In this study, we evaluated the incidence and temporal resolution of dysuria, along with the influence of multiple treatment, clinical, and dosimetric parameters. MATERIALS AND METHODS: Five hundred eighty-one consecutive patients without a preimplant history of transurethral resection of the prostate underwent brachytherapy between January 1998 and December 2001 for clinical T1c-T3a (1997 AJCC) adenocarcinoma of the prostate gland. The evaluated population consisted of the 546 patients who had completed at least two postimplant dysuria evaluations. The median patient follow-up was 26.4 months. In all patients, alpha-blocker therapy was initiated before implantation and continued at least until the International Prostate Symptom Score (IPSS) returned to baseline. The frequency of dysuria was assessed on a 1-5 scale using the IPSS scoring criteria. The dysuria severity was scored on a 1-10 scale. The clinical parameters evaluated included age, T stage, preimplant IPSS, ultrasound volume, and elapsed time since implantation. The treatment parameters included the use of neoadjuvant hormonal manipulation, use of supplemental external beam radiotherapy, isotope, and total implanted seed strength. The dosimetric parameters included values of the minimal dose received by 90% of the prostate, the percentage of prostate volume receiving 100%, 150%, and 200% of the prescribed minimal peripheral dose, and the median and maximal urethral doses. RESULTS: The incidence of dysuria peaked at 52% 1 month after implantation. The median dysuria frequency score was 0 of 5 for all patients and 2 of 5 for those reporting dysuria. The median severity score was 0 of 10 for the entire cohort and 3 of 10 for those reporting dysuria. For the entire group, both the frequency and the severity of dysuria steadily improved with time, with near complete resolution of dysuria at 45 months. For those patients reporting dysuria, neither the frequency nor the severity revealed any durable improvement for approximately 36 months. Patients with dysuria displayed higher postimplant IPSSs. Of the 7 IPSS questions, nocturia and incomplete voiding were the best surrogates for dysuria. The isotope, supplemental external beam radiotherapy, hormonal status, minimal dose received by 90% of the prostate, and urethral dose did not predict for dysuria. CONCLUSIONS: After permanent prostate brachytherapy, dysuria is a relatively common event, but only rarely severe in frequency or intensity. At approximately 45 months after brachytherapy, dysuria appears to resolve in almost all patients.