Most men who have permanent prostate brachytherapy treatment for early-stage prostate cancer experience urinary side effects, but symptoms resolve for the majority of patients within one year following completion of radiation treatment, according to a report published in the September issue of Urology (2009, Vol. 74:3, pp. 601-605).
For this reason, both patients and their physicians need to be aware that genitourinary problems such as retention of urine, obstruction, irritation, and incontinence are commonly experienced toxicities that typically last up to 12 months following treatment and will self-resolve.
To evaluate the percentage of patients who experienced acute urinary short-term side effects and longer-term complications, researchers from M. D. Anderson Cancer Center at the University of Texas in Houston analyzed the medical records of all patients who received prostate brachytherapy between 1998 and 2006. Those who also received external-beam radiation therapy and adjuvant hormone therapy were excluded, leaving a study group of 263 men.
All patients were followed for at least one year after iodine-125 (98%) or palladium-103 (2%) isotopes were implanted. Seventy-five percent of the radiation was delivered in the first four months, with the remainder delivered over the next six months.
Patients were followed for one to more than nine years after treatment, with a median follow-up time of 5.7 years. Thirty-one patients, or 11.8%, experienced 41 urinary complications, of which 49% occurred within 24 months of treatment. An additional 24% had complications within a three-year time period.
Complications included recto-urethral fistula, urethral stenosis, urinary fistula, and severe bladder neck contracture. Lead author Dr. Steven J. Frank, assistant professor of radiation oncology, and colleagues determined that for the majority of patients, urinary symptom-related quality of life decreased to below baseline levels by one month after treatment and reached baseline level by eight months. Symptoms of incontinence did not diminish for at least 12 months for those who experienced it.
The authors noted that the majority of patients experienced grade 1 or 2 complications, which can be reasonably well tolerated.
Related Reading
Preservation of erectile function excellent after prostate brachytherapy, August 22, 2007
Prostate brachytherapy does not always lead to infertility, November 10, 2005
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