Long Term Urinary Sequelae Following 125 Iodine Prostate Brachytherapy
Patients with low-risk prostate cancer (CaP) were initially assessed with an I-PSS questionnaire and given a short course of androgen deprivation therapy for prostates larger than 50cc. Treatment consisted of implantation of 125I seeds by the Seattle technique. Urinary function was evaluated over the long-term using the I-PSS questionnaire.
The study cohort included 484 men treated between 1999 and 2005. Clinical stage was T1 in 65% and T2a in 35%. Median pretreatment PSA was 5.4ng/ml and median followup was 41 months. No urinary sequelae were recorded after one year in 73% of men. The 3 and 5-year Kaplan-Meier sequelae-free rates were 73%and 69%, respectively. An increase of more than 5 points in the I-PSS or a score greater than 15 was found in 23%. Most of these men had resolution with medical management at a median time of 3 months. For 30%, the symptom flare lasted more than 6 months. Age was the only variable that predicted for prolonged voiding symptoms. Urinary urgency was noted in 6.4% of patients and half of these required anticholinergic medications. Only 4 patients (0.8%) had long term symptoms of urgency. Thirteen men (2.7%) required a catheter later than 1 year after treatment and 2 of these required a transurethral resection of the prostate. Urethral stricture occurred in 8 men (1.7%), 3 of whom had required catheterization.
The authors point out that the 27% long term urinary sequelae noted in this series is a single practitioner, single institution result that may not apply to the community in general.
Crook J, Fleshner N, Roberts C, Pond G
J Urol. ePub: November 12, 2008
doi:10.1016/j.juro.2007.08.136
Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D
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Pe termen lung, urinar sechele în urma iod 125 de prostatã Brachytherapy - Long Term Urinary Sequelae Following 125 Iodine Prostate Brachytherapy - articole medicale engleza - startsanatate