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Dubois A, Freton L, Richard C, Haudebert C, Jezequel M, Hascoet J, Peyronnet B. [Genitourinary complications after pelvic radiotherapy: Diagnosis and management]. Prog Urol 2023; 33:563-571. [PMID: 38783761 DOI: 10.1016/j.purol.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 05/25/2024]
Abstract
OBJECTIVE The purpose of this review was to present the different genitourinary complications following pelvic radiotherapy as well as their assessment and treatments. METHODS A review of literature was conducted using Medline/Pubmed database without period restriction. In order to write this article, we also use the 2016 AFSOS, SFRO and AFU recommendations. RESULTS On the one hand, early side effects are common and mild. The symptomatic treatments available generally provide effective relief to patients. On the other hand, late adverse effects need long and complex care. Its side effects alter the quality of life and can be life-threatening. The effects of radiotherapy are irreversible. Except hyperbaric oxygen therapy and hyaluronic acid/chondroitin sulfate instillations, treatments remain symptomatic. Urethrovesical fibroscopy is essential in cases of gross hematuria, and urodynamic assessment (or videourodynamic) can be used in cases of severe vesicosphincter disorders. Pharmacological treatments are less effective than in non-radiation patients, and the morbidity of surgical treatments is higher in this population. CONCLUSION Genitourinary complications after pelvic radiotherapy are frequent and mild in the early phase but rare and severe in the late phase. Their management is based on a vast diagnostic and therapeutic arsenal, but the treatments are only symptomatic, and the sequelae of radiotherapy remains, to date, irreversible.
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Affiliation(s)
- A Dubois
- Service d'urologie, CHU de Rennes, Rennes, France.
| | - L Freton
- Service d'urologie, CHU de Rennes, Rennes, France
| | - C Richard
- Service d'urologie, CHU de Rennes, Rennes, France
| | - C Haudebert
- Service d'urologie, CHU de Rennes, Rennes, France
| | - M Jezequel
- Service d'urologie, CHU de Rennes, Rennes, France
| | - J Hascoet
- Service d'urologie, CHU de Rennes, Rennes, France
| | - B Peyronnet
- Service d'urologie, CHU de Rennes, Rennes, France
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2
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Keller A, Abdelhakiem M, Mulherkar R, Ghanta S, Benoit R, Smith RP, Beriwal S. Effect of short-term corticosteroid usage on acute urinary toxicity following Cs-131 prostate brachytherapy. Brachytherapy 2022; 21:468-474. [PMID: 35514004 DOI: 10.1016/j.brachy.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/27/2022] [Accepted: 03/29/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To evaluate short-term patient reported urinary quality of life scores in patients with prostate cancer treated at our institution with and without perioperative prednisone following Cesium-131 (131Cs) prostate LDR brachytherapy. METHODS AND MATERIALS We started routinely using a perioperative 7-day course of prednisone at a dose of 5 mg per day, beginning 1 day prior to 131Cs prostate LDR brachytherapy from 2013 with goal of improving acute urinary symptomatology. One hundred consecutive patients treated with prednisone were selected, with comparison to 100 consecutive patients who were not treated with prednisone. We analyzed for differences in mean change with standard deviation (SD) in EPIC and AUA scores at 0.5-1 month and 3 months with or without prednisone by Mann-Whitney U Test. Binary logistic regression was performed to assess for impact of prednisone on postoperative urinary catheter use. RESULTS Pretreatment EPIC and AUA scores were available in 197 patients. Less reduction in EPIC US score was noted at 0.5-1.0 month in the group who received prednisone with mean change of -22.9 (SD 15.4) when compared to the group who did not receive prednisone with mean change of -31.7 (SD 19.3), p < 0.01, with significance lost at 3 months. There was no significant difference in acute urinary retention requiring postoperative urinary catheter placement with perioperative prednisone (OR 1.13, p = 0.71). CONCLUSIONS A short course of perioperative low-dose prednisone was associated with less severe worsening in urinary symptoms by the EPIC questionnaire at the 0.5-1.0-month timepoint suggesting some improvement in acute urinary quality of life, although differences did not remain statistically significant at 3 months.
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Affiliation(s)
- Andrew Keller
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Mohamed Abdelhakiem
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Ria Mulherkar
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | | | - Ronald Benoit
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ryan P Smith
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Sushil Beriwal
- Department of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA.
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3
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Uematsu T, Torimoto K, Tanaka N, Asakawa I, Hori S, Yamaki K, Nakai Y, Miyake M, Anai S, Hasegawa M, Fujimoto K. Factors affecting urinary frequency after low-dose-rate brachytherapy for prostate cancer. Low Urin Tract Symptoms 2021; 14:4-9. [PMID: 34288506 DOI: 10.1111/luts.12402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Lower urinary tract symptoms are transiently exacerbated by low-dose-rate brachytherapy (LDR-BT) for prostate cancer and recover to pretreatment levels 1 year thereafter. Generally, these symptoms are influenced by temperature. We aimed to search for factors affecting the lower urinary tract symptoms after seed implant including seasons. METHODS We retrospectively enrolled 812 patients who underwent LDR-BT at Nara Medical University Hospital from January 2010 to December 2018 and for whom the International Prostate Symptom Score, Overactive Bladder Symptom Score, and frequency volume charts were available. We investigated the relationships between lower urinary tract symptoms, 24-hours urinary frequency, 24-hours urinary volume before and after seed implant, radiation dose, and season of seed implant. RESULTS The mean age was 69.5 years. The mean prostate volume was 24.2 mL. The International Prostate Symptom Score, Overactive Bladder Symptom Score, and 24-hours urinary frequency increased until 3 months and gradually decreased over 6 months after seed implant. Multiple linear regression analysis revealed that 24-hours urinary frequency at 3 months after seed implant was significantly influenced by external beam radiotherapy, larger prostate volume before implant, higher 24-hours urinary frequency at baseline, larger 24-hours urinary volume at 3 months after implant, and performance of implant in summer. CONCLUSIONS Lower urinary tract symptoms worsened 3 months after seed implant of LDR-BT regardless of the season of implant. The urinary frequency 3 months after seed implant was slightly lower when seed implant was performed in the summer.
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Affiliation(s)
| | | | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Kashihara, Japan.,Department of Prostate Brachytherapy, Nara Medical University, Kashihara, Japan
| | - Isao Asakawa
- Department of Prostate Brachytherapy, Nara Medical University, Kashihara, Japan.,Department of Radiation Oncology, Nara Medical University, Kashihara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Kaori Yamaki
- Department of Radiation Oncology, Nara Medical University, Kashihara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Satoshi Anai
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Masatoshi Hasegawa
- Department of Radiation Oncology, Nara Medical University, Kashihara, Japan
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Management of Lower Urinary Tract Symptoms after Prostate Radiation. Curr Urol Rep 2021; 22:37. [PMID: 34041611 DOI: 10.1007/s11934-021-01048-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW To present urologists with guidance on how to approach and manage lower urinary tract symptoms (LUTS) in patients who have undergone radiation therapy (RT) for prostate cancer. RECENT FINDINGS There are few studies that specifically examine treatment approaches for LUTS in patients who have undergone prostate cancer RT. LUTS after prostate RT are unique when compared to de novo LUTS. Understanding these distinctions is important for urologists' practice as well as patients' quality of life. Discussion of the risks and management of post-RT LUTS should be included in the shared decision-making process when counseling patients on various treatment options for prostate cancer. Further studies evaluating treatments for storage and voiding symptoms after RT are needed to help guide future care.
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Tsirkas K, Zygogianni A, Kougioumtzopoulou A, Kouloulias V, Liakouli Z, Papatsoris A, Georgakopoulos J, Antypas C, Armpillia C, Dellis A. A-blockers for the management of lower urinary tract symptoms in patients with prostate cancer treated with external beam radiotherapy: a randomized controlled study. World J Urol 2020; 39:1805-1813. [PMID: 32776244 DOI: 10.1007/s00345-020-03398-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/01/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This is a prospective study aiming to assess the efficacy of α-blockers in treating radiotherapy-induced symptoms of the lower urinary tract and its possible prophylactic role on acute urinary retention (AUR) in patients undergoing radical external beam radiotherapy (EBRT) for localized prostate cancer (PCa). METHODS Overall, 108 patients with localized PCa were recruited and randomly assigned in to two groups; 54 patients of Group 1 received tamsulosin 0.4 mg once daily with the initiation of EBRT and for 6 months and 54 patients of Group 2 served as the control group. All patients received radical EBRT and had post-void volume (Vres) assessment. The International Prostate Symptom Score (IPSS) questionnaire and evaluation of episodes of AUR were performed after the end of radiotherapy, at 3 and at 6 months. RESULTS The incidence of AUR was significantly (p = 0.027) lower in group 1 compared to group 2. No independent predictive factors for AUR were identified in regression analysis. The IPSS changes in univariate and multivariate analysis at 3 months showed significant correlation with α-blockers only, while at 6 months showed significant correlation with Vres assessments (at 3 and 6 months) and with α-blockers. Side effects due to medication were mild and none of the patients discontinued the treatment. CONCLUSIONS The selective use of α-blocker appears to prevent AUR in EBRT-treated patients. Although the administration of α-blockers might relieve patient-reported symptoms, there are no established independent predictive factors to distinguish patients who may benefit.
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Affiliation(s)
- Kimon Tsirkas
- 2nd Department of Urology, School of Medicine, Sismanogleion General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Zygogianni
- 1st Department of Radiology, Radiotherapy Unit, Aretaieion Academic Hospital, School of Medicine,, National and Kapodistrian University of Athens, Athens, Greece
| | - Andromachi Kougioumtzopoulou
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 1262, Athens, Chaidari, Greece.
| | - Vasileios Kouloulias
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 1262, Athens, Chaidari, Greece
| | - Zoi Liakouli
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 1262, Athens, Chaidari, Greece
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanogleion General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - John Georgakopoulos
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 1262, Athens, Chaidari, Greece
| | - Christos Antypas
- 1st Department of Radiology, Radiotherapy Unit, Aretaieion Academic Hospital, School of Medicine,, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Armpillia
- 1st Department of Radiology, Radiotherapy Unit, Aretaieion Academic Hospital, School of Medicine,, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Dellis
- 2nd Department of Surgery, Aretaieion Academic Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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A prospective study of oral 5-aminolevulinic acid to prevent adverse events in patients with localized prostate cancer undergoing low-dose-rate brachytherapy: Protocol of the AMBER study. Contemp Clin Trials Commun 2020; 19:100593. [PMID: 32637724 PMCID: PMC7327239 DOI: 10.1016/j.conctc.2020.100593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/07/2020] [Accepted: 06/14/2020] [Indexed: 12/14/2022] Open
Abstract
Background Radiotherapy is one of the most frequently selected treatment options for patients with prostate cancer. However, adverse effects related to the irradiated surrounding normal organs are significant clinical concerns. Specifically, genitourinary and gastrointestinal toxicities can lead to a dramatically reduced quality of life. The aim of this clinical trial is to determine the efficacy of oral 5-aminolevulinic acid (ALA) phosphate with sodium ferrous citrate (SFC) in patients treated with low-dose-rate brachytherapy (LDR-BT) using an iodine-125 seed source. Methods The AMBER study is a prospective, single-center trial in patients with localized prostate cancer undergoing LDR-BT. Patients who undergo supplementary extra-beam radiotherapy are excluded, whereas those who undergo pre-implantation short-term (4–6 months) androgen deprivation therapy to decrease the prostate volume and/or improve oncological outcomes are included. After the screening and registration, the patients will be instructed to take capsules of ALA-SFC twice a day (200 mg and 229.42 mg per day) for 6 months from the day of seed implantation (prescribed radiation dose of 160 Gy). Patient data will be collected before the implantation; during oral ALA-SFC treatment; and 1, 3, 6, 9, and 12 month(s) after seed implantation. The primary endpoint of this trial is the urinary frequency 3 months after seed implantation. At each visit, the 24-h urinary frequency, total voided volume, and mean voided volume on a frequency volume chart and other patient-reported outcomes are recorded. The data of the trial cases will be compared with those of historical controls, who are consecutive patients undergoing LDR-BT without supplementary extra-beam radiotherapy between January 2016 and January 2019. The number of subjects has been set to be 50 for trial cases and 150 for the historical control cases. Pre- and post-treatment clinicopathologic factors are compared between two groups. Discussion The goal of this trial is to determine the potential benefit of ALA-SFC in patients who undergo LDR-BT. To the best of our knowledge, this is the first study investigating the potential clinical benefit of oral ALA-SFC after radiotherapy. More evidence from a further randomized controlled trial is needed to change the standard of care and lead to better post-radiotherapy management. Trial registration This clinical trial was prospectively registered with the Japan Registry of Clinical Trials on 5 December 2019. The reference number is jRCTs051190077, nara0013 (Certified Review Board of Nara Medical University).
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Key Words
- 5-Aminolevulinic acid
- ALA, 5-aminolevulinic acid
- Adverse event
- CTCAE, Common Toxicity Criteria for Adverse Events
- EBRT, extra-beam radiotherapy
- EPIC, Expanded Prostate Cancer Index Composite
- GI, gastrointestinal
- GU, genitourinary
- I-125, iodine-125
- IPSS, International Prostate Symptom Score
- J-POPS, Japanese nationwide prospective cohort study
- LDR-BT, low-dose-rate brachytherapy
- Low-dose-rate brachytherapy
- OABSS, overactive bladder symptom score
- PCa, prostate cancer
- PRO, patient reported outcome
- PSA, prostate-specific antigen
- Prostate cancer
- QOL, quality of life
- Radioprotection
- Radiotherapy
- SFC, sodium ferrous citrate
- SHIM, Sexual Health Inventory for Men
- Urinary frequency
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Dobberfuhl AD. Evaluation and treatment of female stress urinary incontinence after pelvic radiotherapy. Neurourol Urodyn 2018; 38 Suppl 4:S59-S69. [DOI: 10.1002/nau.23839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/19/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Amy D. Dobberfuhl
- Department of UrologyStanford University School of MedicineStanfordCalifornia
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