1
|
Chinenov DV, Shpot EV, Chernov YN, Gerasimov AN, Kazachevskaya LY, Lyapichev KA, Ismailov HM, Tsukkiev ZK, Korolev DO, Rapoport LM. Evaluation of functional and oncological outcomes of localized prostate cancer after different minimally invasive therapeutic methods: A single center experience. Urologia 2024; 91:311-319. [PMID: 38247121 DOI: 10.1177/03915603231226366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVES To study the functional and oncological results of minimally invasive treatment methods: cryoablation, brachytherapy, and high-intensity focused ultrasound (HIFU) therapy of localized prostate cancer in a single hospital. METHODS One hundred sixty patients with localized prostate cancer were treated with minimally invasive methods (53, 52, 55 patients with cryoablation, brachytherapy and HIFU therapy, respectively). Prostate-specific antigen and evaluation of post-procedure biopsies were used as an assessment. The review of functional indicators and quality of life was made with International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), quality of life (QoL) questionnaires. RESULTS Patients after cryoablation showed worse results of oncological control according to positive repeat biopsies, best indicators were observed after brachytherapy. When considering the IPSS results, there were statistically significantly worse scores in the brachytherapy group in the early postoperative period, these differences do not reach statistical significance in the late period in the brachytherapy and cryoablation groups. Patients in the cryoablation group showed worse indicators of IIEF-5; in the early postoperative period; in the late follow-up period, the indicators of erectile function in patients in the cryoablation group did not statistically significantly differ from those in patients after brachytherapy. Patients after HIFU therapy showed fewer cases of de novo erectile dysfunction during the follow-up period of 3 years, higher average IIEF-5 scores, lower IPSS scores and better QoL results. CONCLUSION The recurrence of prostate cancer was statistically significantly higher in the International Society of Urological Pathology (ISUP) 3 grade group. HIFU therapy had better urination indicators compared to other groups, that can be associated with the laser enucleation of prostatic hyperplasia. The advantage was noted in patients after HIFU therapy when comparing the parameters to the IIEF-5 thus, HIFU treatment had a better impact on patients' QoL with localized prostate cancer.
Collapse
Affiliation(s)
- D V Chinenov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - E V Shpot
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Y N Chernov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - A N Gerasimov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - L Y Kazachevskaya
- The Pathology Residency Program at Louisiana State University Health Sciences Center in Shreveport, LA, USA
| | - K A Lyapichev
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - H M Ismailov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Z K Tsukkiev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - D O Korolev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - L M Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| |
Collapse
|
2
|
Taniguchi T, Kawase M, Nakane K, Nakano M, Iinuma K, Kato D, Takai M, Tobisawa Y, Mori T, Takano H, Kumano T, Matsuo M, Ito T, Koie T. Prognostic Factors for Resolution Delay of Lower Urinary Tract Symptoms in Patients with Prostate Cancer after Low-Dose-Rate Brachytherapy. Cancers (Basel) 2023; 15:4048. [PMID: 37627078 PMCID: PMC10452417 DOI: 10.3390/cancers15164048] [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: 07/11/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Urinary storage symptoms after low-dose-rate brachytherapy (LDR-BT) with iodine-125 have been noted to be less likely to improve to baseline compared to voiding symptoms. This study aimed to evaluate the chronological changes in the overactive bladder symptom score (OABSS) and the time-to-resolution of OABSS in patients undergoing LDR-BT. Patients with prostate cancer who underwent LDR-BT at Gifu University Hospital were enrolled. The OABSS was evaluated before and after LDR-BT. Patients were divided into the OABSS resolution and resolution delay groups, and the association between OABSS resolution delay and clinicopathological covariates was evaluated. In total, 237 patients were enrolled in this study, with a median follow-up of 88.3 months. The OABSS in both groups worsened at 3 months following operation and gradually recovered at 9 months; however, the OABSS in the resolution delay group tended to worsen again after that. In the multivariate analysis, preoperative OABSS and the change from baseline to maximal OABSS were associated with OABSS resolution. To our knowledge, this is the first study to evaluate the delayed resolution of OABSS after LDR-BT in patients with prostate cancer. A low baseline OABSS and significant changes in the OABSS from baseline were independent predictors of delayed OABSS resolution.
Collapse
Affiliation(s)
- Tomoki Taniguchi
- Department of Urology, Ogaki Municipal Hospital, 4-86 Minaminokawacho, Ogaki, Gifu 5038502, Japan;
| | - Makoto Kawase
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (M.K.); (K.N.); (K.I.); (D.K.); (M.T.); (Y.T.)
| | - Keita Nakane
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (M.K.); (K.N.); (K.I.); (D.K.); (M.T.); (Y.T.)
| | - Masahiro Nakano
- Department of Urology, Gifu Prefectural General Medical Center, 4-6-1 Noisiki, Gifu 5008717, Japan;
| | - Koji Iinuma
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (M.K.); (K.N.); (K.I.); (D.K.); (M.T.); (Y.T.)
| | - Daiki Kato
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (M.K.); (K.N.); (K.I.); (D.K.); (M.T.); (Y.T.)
| | - Manabu Takai
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (M.K.); (K.N.); (K.I.); (D.K.); (M.T.); (Y.T.)
| | - Yuki Tobisawa
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (M.K.); (K.N.); (K.I.); (D.K.); (M.T.); (Y.T.)
| | - Takayuki Mori
- Department of Radiology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (T.M.); (H.T.); (T.K.); (M.M.)
| | - Hirota Takano
- Department of Radiology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (T.M.); (H.T.); (T.K.); (M.M.)
| | - Tomoyasu Kumano
- Department of Radiology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (T.M.); (H.T.); (T.K.); (M.M.)
| | - Masayuki Matsuo
- Department of Radiology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (T.M.); (H.T.); (T.K.); (M.M.)
| | - Takayasu Ito
- Center for Clinical Training and Career Development, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan;
| | - Takuya Koie
- Department of Urology, Ogaki Municipal Hospital, 4-86 Minaminokawacho, Ogaki, Gifu 5038502, Japan;
| |
Collapse
|
3
|
Ito M, Makita C, Mori T, Takano H, Kumano T, Matsuo M, Iinuma K, Kawase M, Nakane K, Nakano M, Koie T. Associations of Clinical and Dosimetric Parameters with Urinary Toxicities after Prostate Brachytherapy: A Long-Term Single-Institution Experience. Curr Oncol 2023; 30:5680-5689. [PMID: 37366909 DOI: 10.3390/curroncol30060426] [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: 05/18/2023] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
To examine the association of clinical, treatment, and dose parameters with late urinary toxicity after low-dose-rate brachytherapy (LDR-BT) for prostate cancer, we retrospectively studied patients with prostate cancer who underwent LDR-BT from January 2007 through December 2016. Urinary toxicity was assessed using the International Prostate Symptom Score (IPSS) and Overactive Bladder (OAB) Symptom Score (OABSS). Severe and moderate lower urinary tract symptoms (LUTS) were defined as IPSS ≥ 20 and ≥ 8, respectively; OAB was defined as a nocturnal frequency of ≥ 2 and a total OABSS of ≥ 3. In total, 203 patients (median age: 66 years) were included, with a mean follow-up of 8.4 years after treatment. The IPSS and OABSS worsened after 3 months of treatment; these scores improved to pretreatment levels after 18-36 months in most patients. Patients with a higher baseline IPSS and OABSS had a higher frequency of moderate and severe LUTS and OAB at 24 and 60 months, respectively. LUTS and OAB at 24 and 60 months were not correlated with the dosimetric factors of LDR-BT. Although the rate of long-term urinary toxicities assessed using IPSS and OABSS was low, the baseline scores were related to long-term function. Refining patient selection may further reduce long-term urinary toxicity.
Collapse
Affiliation(s)
- Masaya Ito
- Department of Radiation Oncology, Gifu Takayama Red Cross Hospital, 3-11, Tenmancho, Takayama City 500-8717, Gifu, Japan
- Department of Radiology, Gifu University Hospital, 1-1, Yanagido, Gifu City 500-1194, Gifu, Japan
| | - Chiyoko Makita
- Department of Radiology, Gifu University Hospital, 1-1, Yanagido, Gifu City 500-1194, Gifu, Japan
| | - Takayuki Mori
- Department of Radiology, Gifu University Hospital, 1-1, Yanagido, Gifu City 500-1194, Gifu, Japan
| | - Hirota Takano
- Department of Radiology, Gifu University Hospital, 1-1, Yanagido, Gifu City 500-1194, Gifu, Japan
| | - Tomoyasu Kumano
- Department of Radiology, Gifu University Hospital, 1-1, Yanagido, Gifu City 500-1194, Gifu, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University Hospital, 1-1, Yanagido, Gifu City 500-1194, Gifu, Japan
| | - Koji Iinuma
- Department of Urology, Gifu University Hospital, 1-1, Yanagido, Gifu City 500-1194, Gifu, Japan
| | - Makoto Kawase
- Department of Urology, Gifu University Hospital, 1-1, Yanagido, Gifu City 500-1194, Gifu, Japan
| | - Keita Nakane
- Department of Urology, Gifu University Hospital, 1-1, Yanagido, Gifu City 500-1194, Gifu, Japan
| | - Masahiro Nakano
- Department of Urology, Gifu Prefectural General Medical Center, 4-6-1, Noisshiki, Gifu City 500-8717, Gifu, Japan
| | - Takuya Koie
- Department of Urology, Gifu University Hospital, 1-1, Yanagido, Gifu City 500-1194, Gifu, Japan
| |
Collapse
|
4
|
Kwan W, Bahl G, Kim D, Ye A, Gagne I, Alexander A, Hejazi S. Acute Toxicity of Ultrahypofractionation Compared to Moderate Hypofractionation in Prostate Cancer Treatment - a Randomized Trial. Int J Radiat Oncol Biol Phys 2022; 113:1036-1043. [PMID: 35417763 DOI: 10.1016/j.ijrobp.2022.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/28/2022] [Accepted: 04/05/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To report on the early toxicities and quality of life (QOL) of localized prostate cancer radiotherapy in a randomized trial comparing moderate hypofractionation (MHF) to ultrahypofractionation (UHF) MATERIALS AND METHODS: Intermediate to high risk localized prostate cancer patients were randomized to radiotherapy with MHF (70 Gy in 28 daily fractions) or UHF (36.25 Gy in 5 weekly fractions). Early toxicities (CTCAE and RTOG/SOMA scales) and patient reported QOL (EPIC questionnaire) were analysed when all patients had a minimum of 6 months follow-up. RESULTS Eighty participants were randomized but two withdrew from radiotherapy. Analysis was done on 78 patients. The two arms were balanced in key patient and disease characteristics except for a statistically worse baseline urinary function in the UHF arm (IPSS > 7: 68% vs 36% p = 0.004). There are no statistically significant differences between the two arms in Grade 3 or Grade 2 toxicities: ≥ Grade 3 - MHF 8%, UHF 2% (p=0.235); ≥ Grade 2 MHF 36%, UHF 24% (p=0.235). There are also no significant differences in percentages of patients with a "minimal important change" of QOL in the Incontinence (MHF 36%, UHF 33% p =0.746), Irritative/Obstructive (MHF 56%, UHF 74% p=0.074) or Bowel domains (MHF 58%, UHF 52% p=0.508) on the EPIC questionnaire. CONCLUSIONS UHF radiotherapy for prostate cancer is well tolerated and there were no significant differences in toxicities and quality of life changes between UHF and MHF up to six months after treatment in the current trial.
Collapse
|
5
|
Boyce-Fappiano D, Bathala TK, Ye R, Pasalic D, Gjyshi O, Pezzi TA, Noticewala SS, McGinnis GJ, Maroongroge S, Kuban DA, Nguyen QN, McGuire SE, Hoffman KE, Choi S, Tang C, Kudchadker RJ, Frank SJ. Predictors of urinary toxicity with MRI-assisted radiosurgery for low-dose-rate prostate brachytherapy. Brachytherapy 2020; 19:574-583. [PMID: 32682778 DOI: 10.1016/j.brachy.2020.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/31/2020] [Accepted: 06/08/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE MRI-assisted radiosurgery (MARS) is a modern technique for prostate brachytherapy that provides superior soft tissue contrast. The purpose of this analysis was to evaluate treatment planning factors associated with urinary toxicity, particularly damage to the membranous urethra (MUL) and external urethral sphincter (EUS), after MARS. MATERIAL AND METHODS We retrospectively reviewed 227 patients treated with MARS. Comparisons were made between several factors including preimplantation length of the MUL and EUS dosimetric characteristics after implantation with longitudinal changes in American Urological Association (AUA) urinary symptom score. RESULTS Rates of grade 3 urinary incontinence and obstructive urinary symptoms were 4% and 2%. A piecewise mixed univariate model revealed that MUL and V200, V150, V125, and D5 to the EUS were all associated with increased rates of urinary toxicity over time. On univariate logistic regression, MUL >14.2 mm (odds ratio [OR] 2.03 per cm3, 95% confidence interval [CI] 1.10-3.77, p = 0.025), V125 to the EUS (OR 3.21 cm3, 95% CI 1.18-8.71, p = 0.022), and use of the I-125 isotope (OR 3.45, 95% CI 1.55-7.70, p = 0.001) were associated with subacute urinary toxicity (i.e., that occurring at 4-8 months). Optimal dose-constraint limits to the EUS were determined to be V200 < 0.04 cm3 (p = 0.002), V150 < 0.12 cm3 (p = 0.041), V125 < 0.45 cm3 (p = 0.033), D30 < 160 Gy (p = 0.004), and D5 < 218 Gy (p = 0.016). CONCLUSIONS MARS brachytherapy provides detailed anatomic information for treatment planning, implantation, and quality assurance. Overall rates of urinary toxicity are low; however, several dosimetric variables associated with the EUS were found to correlate with urinary toxicity.
Collapse
Affiliation(s)
- David Boyce-Fappiano
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tharakeswara K Bathala
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rong Ye
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dario Pasalic
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Olsi Gjyshi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Todd A Pezzi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sonal S Noticewala
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gwendolyn J McGinnis
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sean Maroongroge
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Deborah A Kuban
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sean E McGuire
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Karen E Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Seungtaek Choi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rajat J Kudchadker
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| |
Collapse
|
6
|
Martell K, Roy S, Meyer T, Stosky J, Jiang W, Thind K, Roumeliotis M, Bosch J, Angyalfi S, Quon H, Husain S. Analysis of outcomes after non-contour-based dose painting of dominant intra-epithelial lesion in intra-operative low-dose rate brachytherapy. Heliyon 2020; 6:e04092. [PMID: 32548323 PMCID: PMC7286970 DOI: 10.1016/j.heliyon.2020.e04092] [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: 02/14/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose To compare the outcomes of patients with intermediate risk prostate cancer (IR-PCa) treated with low-dose rate I-125 seed brachytherapy (LDR-BT) and targeted dose painting of a histologic dominant intra-epithelial lesion (DIL) to those without a DIL. Methods 455 patients with IR-PCa were treated at a single center with intra-operatively planned LDR-BT, each following the same in-house dose constraints. Patients with a DIL on pathology had hot spots localized to that region but no specific contouring during the procedure. Results 396 (87%) patients had a DIL. Baseline tumor characteristics and overall prostate dosimetry were similar between patients with and without DIL except the median number of biopsy cores taken: 10 (10–12) vs 12 (10–12) (p = 0.002). 19 (5%) and 18 (5%) of patients with and 1 (2%) and 0 (0%) of those without DIL experienced CTCAE grade 2 and 3 toxicity respectively. Overall, toxicity grade did not significantly correlate with presence of DIL (p = 0.10). Estimated 7-year freedom from biochemical failure (FFBF) was 84% (95% confidence interval: 79–89) and 70% (54–89) in patients with and without a DIL (log-rank p = 0.315). In DIL patients, cox regression revealed location of DIL (“Base” vs “Apex” HR: 1.03; 1.00–1.06; p = 0.03) and older age (70 vs 60 HR: 1.62; 1.06–2.49; p = 0.03) was associated with poor FFBF. Conclusions Targeting DIL through dose painting during intraoperatively planned LDR-BT provided no statistically significant change in FFBF. Patients with DILs in the prostate base had slightly lower FFBF despite DIL boost.
Collapse
Affiliation(s)
- Kevin Martell
- University of Calgary, Department of Oncology, Calgary, AB, Canada.,Alberta Health Services, Calgary Zone, Calgary, AB, Canada
| | - Soumyajit Roy
- University of Calgary, Department of Oncology, Calgary, AB, Canada.,Alberta Health Services, Calgary Zone, Calgary, AB, Canada.,Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tyler Meyer
- University of Calgary, Department of Oncology, Calgary, AB, Canada.,Alberta Health Services, Calgary Zone, Calgary, AB, Canada
| | - Jordan Stosky
- University of Calgary, Department of Oncology, Calgary, AB, Canada.,Alberta Health Services, Calgary Zone, Calgary, AB, Canada
| | - Will Jiang
- University of Calgary, Department of Oncology, Calgary, AB, Canada.,Alberta Health Services, Calgary Zone, Calgary, AB, Canada
| | - Kundan Thind
- University of Calgary, Department of Oncology, Calgary, AB, Canada.,Alberta Health Services, Calgary Zone, Calgary, AB, Canada
| | - Michael Roumeliotis
- University of Calgary, Department of Oncology, Calgary, AB, Canada.,Alberta Health Services, Calgary Zone, Calgary, AB, Canada
| | - John Bosch
- Alberta Health Services, Calgary Zone, Calgary, AB, Canada
| | - Steve Angyalfi
- University of Calgary, Department of Oncology, Calgary, AB, Canada.,Alberta Health Services, Calgary Zone, Calgary, AB, Canada
| | - Harvey Quon
- University of Calgary, Department of Oncology, Calgary, AB, Canada.,Alberta Health Services, Calgary Zone, Calgary, AB, Canada
| | - Siraj Husain
- University of Calgary, Department of Oncology, Calgary, AB, Canada.,Alberta Health Services, Calgary Zone, Calgary, AB, Canada
| |
Collapse
|
7
|
Kobayashi K, Murakami N, Takahashi K, Inaba K, Igaki H, Hamamoto R, Itami J. A Population-based Statistical Model for Investigating Heterogeneous Intraprostatic Sensitivity to Radiation Toxicity After 125I Seed Implantation. In Vivo 2020; 33:2103-2111. [PMID: 31662544 DOI: 10.21873/invivo.11710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/28/2019] [Accepted: 09/03/2019] [Indexed: 11/10/2022]
Abstract
AIM To develop a population-based statistical model in order to find a spatial pattern of dose distribution which is related to lower urinary tract symptoms (LUTS) after iodine-125 (125I) seed implantation for prostate cancer. PATIENTS AND METHODS A total of 75 patients underwent 125I seed implantation for prostate cancer. Principal component analysis was applied to the standardized dose array and for each patient dose distribution was uniquely characterized by a combination of weighted eigenvectors. The correlation between eigenvectors and the severity of LUTS was investigated with linear regression analysis. RESULTS Eight eigenvectors were identified as being significantly associated with the severity of LUTS (p<0.05). Multivariate regression model identified that intraprostatic parameters, which were positively associated with the severity of LUTS, were distributed around a portion of the urethral base and a peripheral region of the prostate. CONCLUSION We established a population-based statistical model that may indicate a significant dose pattern associated with the severity of radiation toxicity.
Collapse
Affiliation(s)
- Kazuma Kobayashi
- Division of Molecular Modification and Cancer Biology, National Cancer Center Research Institute, Tokyo, Japan .,Cancer Translational Research Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan.,Department of NCC Cancer Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kana Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Koji Inaba
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ryuji Hamamoto
- Division of Molecular Modification and Cancer Biology, National Cancer Center Research Institute, Tokyo, Japan.,Cancer Translational Research Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan.,Department of NCC Cancer Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
8
|
A Review of Permanent Prostate Brachytherapy as Practiced in Japan. Brachytherapy 2019. [DOI: 10.1007/978-981-13-0490-3_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
9
|
Onishi K, Tanaka N, Miyake M, Nakai Y, Anai S, Torimoto K, Yamaki K, Asakawa I, Hasegawa M, Fujii T, Konishi N, Fujimoto K. Changes in lower urinary tract symptoms after iodine-125 brachytherapy for prostate cancer. Clin Transl Radiat Oncol 2018; 14:51-58. [PMID: 30547097 PMCID: PMC6282112 DOI: 10.1016/j.ctro.2018.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 12/12/2022] Open
Abstract
Patients who received BT experienced acute urinary morbidity 3 months after BT of the prostate. Acute urinary symptoms gradually improved with time and returned to BL at 36 months. Storage symptoms take longer to return to BL compared with voiding symptoms.
Purpose To investigate chronological changes in lower urinary tract symptoms (LUTS) in patients who received iodine-125 brachytherapy (BT) for prostate cancer. Methods We enrolled 706 patients who received BT. Of these, 265 (38%) received BT combined with external beam radiation therapy (EBRT). An International Prostate Symptom Score (IPSS), IPSS quality of life (IPSS-QOL) score, and overactive bladder symptom score (OABSS) were recorded before BT (baseline, BL), and 1, 3, 6, 12, 24, 36, 48, and 60 months after BT. The sum of frequency (2), urgency (4) and nocturia (7) of the IPSS questionnaire was defined as the storage symptoms score, whereas the sum of emptying (1), intermittency (3), weak stream (5), and hesitancy (6) was defined as the voiding symptom score. Results Total IPSS significantly increased at 3 months following BT compared with BL (mean score: 17.1 vs. 7.99, P < 0.001) and returned to BL by 36 months. The storage symptom score did not return to BL 36 months after BT. Total OABSS significantly increased 3 months after BT compared with BL (mean score: 6.52 vs. 3.45, P < 0.001), and returned to BL 48 months after BT. The IPSS-QOL score was the highest score (mean score: 2.46 vs. 3.9, P < 0.001) 3 months after BT and returned to BL 48 months after BT, however the IPSS-QOL score was lower than BL (mean score: 2.01 vs 2.46, P < 0.001) at 60 months. The risk factors for LUTS within 1 year after BT were BL IPSS (P < 0.001) and PV (P < 0.001). Patients who received combined EBRT experienced transient storage symptoms 24 and 36 months after BT, whereas those who received BT alone did not. However, the storage symptom score of the patients who received combined EBRT was improving 48 months after BT and eventually showed no significant difference compared with those treated with BT alone. Conclusion Three months after BT, LUTS, including storage symptoms, deteriorated the most but improved with time. The urinary symptom in patients who received combined EBRT can potentially flare again in 24 and 36 months after BT. Knowledge of changes in LUTS associated with BT may influence treatment recommendations and enable patients to make better-informed decisions.
Collapse
Key Words
- BL, baseline
- BT, brachytherapy
- Brachytherapy
- EBRT, external beam radiation therapy
- GS, Gleason score
- IMRT, intensity modulated radiation therapy
- IQR, interquartile
- LUTS, lower urinary tract symptoms
- Lower urinary tract symptom
- NADT, neoadjuvant androgen deprivation therapy
- PV, prostate volume
- Prostate cancer
- QOL, quality of life
- Quality of life
- Urinary symptom flare
Collapse
Affiliation(s)
- Kenta Onishi
- Department of Urology, Nara Medical University, Japan
| | | | - Makito Miyake
- Department of Urology, Nara Medical University, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Japan
| | - Satoshi Anai
- Department of Urology, Nara Medical University, Japan
| | | | - Kaori Yamaki
- Department of Radiation Oncology, Nara Medical University, Japan
| | - Isao Asakawa
- Department of Radiation Oncology, Nara Medical University, Japan
| | | | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Japan
| | - Noboru Konishi
- Department of Diagnostic Pathology, Kouseikai Takai Hospital, Japan
| | | |
Collapse
|
10
|
Coquet JB, Delage F, Fourcade A, Callerot P, Goasduff G, Boussion N, Rousseau B, Serey-Eiffel S, Malhaire JP, Pradier O, Schick U, Fournier G, Valeri A. Evaluation of the "Quadrella" at 3 years: New index to assess functional and oncological performance specific to prostate brachytherapy. Brachytherapy 2018; 17:782-787. [PMID: 29936129 DOI: 10.1016/j.brachy.2018.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/01/2018] [Accepted: 05/16/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE "Quadrella" index has been recently developed to assess oncological and functional outcomes after prostate brachytherapy (PB). We aimed to evaluate this index at 1, 2, and 3 years, using validated questionnaires, assessed prospectively. METHODS AND MATERIALS From 08/2007 to 01/2013, 193 patients underwent 125Iodine PB for low-risk or favorable intermediate-risk prostate adenocarcinoma. Inclusion criteria were as follows: no incontinence (International Continence Society Index initial score = 0) and good erectile function (International Index of Erectile Function-5 items: >16). One hundred patients were included (mean age: 64 y). Postimplantation intake of phosphodiesterase inhibitors was not considered as failure. The "Quadrella" index was defined by the absence of biochemical recurrence (Phoenix criteria), significant erectile dysfunction (ED) (Index of Erectile Function-5 items: >16), urinary toxicity (UT) (International Prostate Score Symptom [IPSS] <15 or IPSS> 15 with ΔIPSS <5), and rectal toxicity (RT) (Radiation Therapy Oncology Group = 0). RESULTS At 12 months, 90 patients were evaluable: 42/90 (46.7%) achieved Quadrella. The main criteria for failure were as follows: ED in 77.1% (37/48) of cases, RT in 20.8% (10/48) of cases, and UT in 12.5% (9/57) of cases. At 24 and 36 months, 59.3% (48/81) and 61.1% (44/72) of patients achieved Quadrella, respectively. The main cause of failure was ED in 69.7% (23/33) and 85.7% (24/28) of cases, while RT was involved in 21.2% (7/33) and in 3.6% (1/28) of cases, and UT in 9.1% (3/33) and 3.6% (1/28) of cases. Only one case of biochemical recurrence was observed (i.e., 1/28 = 3.6% at 3 y). CONCLUSIONS The Quadrella can be used at 1, 2, and 3 years after PB. It allows to take into account the urinary and RT specific to PB. ED was the main cause of failure. This index will be useful to assess midterm and long-term results.
Collapse
Affiliation(s)
- Jean-Baptiste Coquet
- CHU Brest, Service Urologie, Brest, France; Université de Brest, Faculté de Médecine et des Sciences de la Santé, Brest, France; Université de Bretagne Occidentale, Bretagne, France.
| | | | - Alexandre Fourcade
- CHU Brest, Service Urologie, Brest, France; Université de Brest, Faculté de Médecine et des Sciences de la Santé, Brest, France; Université de Bretagne Occidentale, Bretagne, France
| | - Pierre Callerot
- CHU Brest, Service Urologie, Brest, France; Université de Brest, Faculté de Médecine et des Sciences de la Santé, Brest, France; Université de Bretagne Occidentale, Bretagne, France
| | | | | | | | | | | | - Olivier Pradier
- Université de Brest, Faculté de Médecine et des Sciences de la Santé, Brest, France; Université de Bretagne Occidentale, Bretagne, France; CHU Brest, Service de Radiothérapie, Brest, France
| | - Ulrike Schick
- Université de Brest, Faculté de Médecine et des Sciences de la Santé, Brest, France; Université de Bretagne Occidentale, Bretagne, France; CHU Brest, Service de Radiothérapie, Brest, France
| | - Georges Fournier
- CHU Brest, Service Urologie, Brest, France; Université de Brest, Faculté de Médecine et des Sciences de la Santé, Brest, France; Université de Bretagne Occidentale, Bretagne, France; CeRePP, Paris, France
| | - Antoine Valeri
- CHU Brest, Service Urologie, Brest, France; Université de Brest, Faculté de Médecine et des Sciences de la Santé, Brest, France; Université de Bretagne Occidentale, Bretagne, France; CeRePP, Paris, France
| |
Collapse
|
11
|
Evaluation of intraoperative magnetic resonance imaging/ultrasound fusion optimization for low-dose-rate prostate brachytherapy. J Contemp Brachytherapy 2017; 9:309-315. [PMID: 28951749 PMCID: PMC5611458 DOI: 10.5114/jcb.2017.69412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 07/14/2017] [Indexed: 11/26/2022] Open
Abstract
Purpose Intraoperative planning with transrectal ultrasound (US) is used for accurate seed placement and optimal dosimetry in prostate brachytherapy. However, prostate magnetic resonance imaging (MRI) has shown superiority in delineation of prostate anatomy. Accordingly, MRI/US fusion may be useful for accurate intraoperative planning. We analyzed planning with MRI/US fusion to compare differences in dosimetry and volume to that derived from the postoperative computed tomography (CT). Material and methods Twenty patients underwent preoperative prostate MRI, which was fused intraoperatively with US during prostate brachytherapy. Intraoperative 125I or 103Pd seed placement was modified by the use of MRI fusion when indicated. Following implantation, dose comparisons were made between data derived from MRI/US and that from post-operative CT scans. Plan parameters analyzed included the D90 (dose to 90% of the prostate), rectal D30, V30 (volume of the rectum receiving 30 percent of dose), and prostate V100. Results The median number of seeds implanted per patient was seventy-six. The MRI measured prostate volume, which was on average 4.47 cc larger than the CT measured prostate volume. In 9 patients, the apex of the prostate was better identified under MRI with the fusion protocol, and an average of 4 fewer seeds were required to be placed in the apex/urinary sphincter region. Both MRI and US individually showed a reduced intraoperative prostate D90 in comparison to the postoperative CT, with a larger mean difference for MRI in comparison with US (9.71 vs. 4.31 Gy, p = 0.007). This was also true for the prostate V100 (5.18 vs. 2.73 cc, p = 0.009). Post-operative CT underestimated rectal D30 and V30 in comparison to both MRI and US with MRI showing a larger mean difference than US for D30 (40.64 vs. 35.92 Gy, p = 0.04) and V30 (50.20 vs. 44.38 cc, p = 0.009). Conclusions The MRI/US fusion demonstrated greater prostate volume compared to standard CT/US based planning likely due to the better resolution of the prostate apex. Furthermore, rectal dose was underestimated with CT vs. MRI based planning. Additional study is required to assess long-term clinical implications of disease control and effects on long-term toxicity, especially as related to the rectum and urinary sphincter. MRI/US intraoperative fusion may improve prostate dosimetry while sparing the rectum and urethra, potentially impacting disease control and late toxicity.
Collapse
|
12
|
Miyake M, Tanaka N, Asakawa I, Hori S, Morizawa Y, Tatsumi Y, Nakai Y, Inoue T, Anai S, Torimoto K, Aoki K, Hasegawa M, Fujii T, Konishi N, Fujimoto K. Assessment of lower urinary symptom flare with overactive bladder symptom score and International Prostate Symptom Score in patients treated with iodine-125 implant brachytherapy: long-term follow-up experience at a single institute. BMC Urol 2017; 17:62. [PMID: 28806948 PMCID: PMC5556596 DOI: 10.1186/s12894-017-0251-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 08/03/2017] [Indexed: 02/18/2023] Open
Abstract
Background The aim of this study was to evaluate the combined use of the overactive bladder symptom score (OABSS) and International Prostate Symptom Score (IPSS) as an assessment tool for urinary symptom flare after iodine-125 (125I) implant brachytherapy. The association between urinary symptom flare and prostate-specific antigen (PSA) bounce was investigated. Methods Changes in the IPSS and OABSS were prospectively recorded in 355 patients who underwent seed implantation. The percentage distribution of patients according to the difference between the flare peak and post-implant nadir was plotted to define significant increases in the scores. The clinicopathologic characteristics, treatment parameters, and post-implant dosimetric parameters were compared between the non-flare and flare groups. PSA bounce was defined as an elevation of ≥0.1 ng/mL or ≥0.4 ng/mL compared to the previous lowest value, followed by a decrease to a level at or below the pre-bounce value. Results A clinically significant increase required an IPSS increase of at least 12 points and an OABSS increase of at least 6 points based on a time-course analysis of total scores and the QOL index. Assessment only by IPSS failed to detect 40 patients (11%) who had urinary symptom flare according to the OABSS. Univariate and multivariate analyses revealed that patients treated with higher biologically effective doses and those without diabetes mellitus had higher risks of urinary flare. There was no statistical correlation between the incidence and time of urinary symptom flare onset and that of a PSA bounce. Conclusions To our knowledge, this is the first report to prove the clinical potential of the OABSS as an assessment tool for urinary symptom flare after seed implantation. Our findings showed that persistent lower urinary tract symptoms after seed implantation were attributed to storage rather than to voiding issues. We believe that assessment with the OABSS combined with the IPSS would aid in decision-making in terms of timing, selection of a treatment intervention, and assessment of the outcome. Electronic supplementary material The online version of this article (doi:10.1186/s12894-017-0251-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Makito Miyake
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan.
| | - Isao Asakawa
- Department of Radiation Oncology, Nara Medical University, Nara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan
| | - Yoshihiro Tatsumi
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan.,Department of Pathology, Nara Medical University, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan
| | - Takeshi Inoue
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan
| | - Satoshi Anai
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan
| | - Katsuya Aoki
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan
| | | | - Tomomi Fujii
- Department of Pathology, Nara Medical University, Nara, Japan
| | - Noboru Konishi
- Department of Pathology, Nara Medical University, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Nara, 634-8522, Japan
| |
Collapse
|
13
|
Yan M, Xue P, Wang K, Gao G, Zhang W, Sun F. Does combination therapy with tamsulosin and trospium chloride improve lower urinary tract symptoms after SEEDS brachytherapy for prostate cancer compared with tamsulosin alone? : A prospective, randomized, controlled trial. Strahlenther Onkol 2017; 193:714-721. [PMID: 28612083 DOI: 10.1007/s00066-017-1162-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare the efficacy of combination therapy with an alpha-blocker and an anticholinergic to monotherapy with an alpha blocker on lower urinary tract symptoms (LUTS) following brachytherapy in prostate cancer patients. MATERIAL AND METHODS A total of 124 patients that had been clinically diagnosed with localized prostate cancer and underwent prostate brachytherapy were enrolled in the present study. Patients were randomized and allocated to two groups, including 60 to the combination group (tamsulosin 0.2 mg/day and trospium chloride 20 mg twice daily) and 64 to the monotherapy group (tamsulosin 0.2 mg/day). Treatment began 1 day after brachytherapy and continued for 6 months. LUTS were compared between the two groups using the total International Prostate Symptom Score (IPSS), storage and voiding IPSS subscores, quality of life (QoL) scores, maximum flow rate (Qmax), and postvoid residual (PVR) urine volume at 1, 3, 6, and 12 months after implantation. RESULTS In all, 111 patients were ultimately analyzed in the study. Compared with pretreatment scores, a significant increase in total IPSS was found at 1, 3, and 6 months in both groups, but no statistically significant differences were observed between the two groups. The combination therapy group showed a greater decrease in the IPSS storage score compared with the monotherapy group at 1, 3, and 6 months (p = 0.031, 0.030 and 0.042, respectively). Patients receiving tamsulosin plus trospium chloride also showed significant improvements in QoL at 1 and 3 months compared with tamsulosin alone (P = 0.039, P = 0.047). Between the two groups, there was no significant difference in IPSS voiding score, Qmax, and PVR from baseline to each point of the study period. CONCLUSIONS Combination therapy with tamsulosin and trospium chloride helped to improve IPSS storage symptoms and Qol scores in prostate brachytherapy patients with LUTS compared with tamsulosin monotherapy.
Collapse
Affiliation(s)
- Miao Yan
- Department of Oncology, First People Hospital of Lianyungang, Lianyungang, Jiangsu province, China
| | - Peng Xue
- Department of Urology, First People Hospital of Lianyungang, 222002, Lianyungang, Jiangsu province, China
| | - Kunpeng Wang
- Department of Urology, First People Hospital of Lianyungang, 222002, Lianyungang, Jiangsu province, China
| | - Guojun Gao
- Department of Urology, the Affiliated Hospital of Weifang Medical College, Weifang, Shandong province, China
| | - Wei Zhang
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fanghu Sun
- Department of Urology, First People Hospital of Lianyungang, 222002, Lianyungang, Jiangsu province, China.
| |
Collapse
|
14
|
Wang C, Chen Z, Sun W, Yasin Y, Zhang C, Ma X, Chen J, Shen J, Hua Y, Cai Z. Palliative treatment of pelvic bone tumors using radioiodine ( 125I) brachytherapy. World J Surg Oncol 2016; 14:294. [PMID: 27884196 PMCID: PMC5123313 DOI: 10.1186/s12957-016-1050-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 11/07/2016] [Indexed: 12/25/2022] Open
Abstract
Background Complete resection of pelvic bone tumors, especially recurrent and metastatic ones, is often impossible to achieve using conventional surgery. This study aimed to assess the benefits and adverse effects of computed tomography (CT)-guided radioiodine (125I) brachytherapy for inoperable recurrent and metastatic bone tumors of the pelvis. Methods This was a retrospective study of 22 patients with confirmed pelvic bone tumors (10 females and 12 males; 15–84 years; 21 with primary pelvic tumor and one with pelvic metastasis). CT-guided 125I brachytherapy was performed using 9–21 125I seeds (radioactivity of 0.5–0.7 mCi). Seed implantation was validated by postoperative CT scanning. Complications, pain, survival, and CT-estimated tumor size were carried out to evaluate the therapeutic benefits. Results Postoperative CT scans revealed satisfactory 125I seed implantation, and the radiation dose delivered to 90% of the target area (D90) was higher than the prescription dose (PD). No obvious complications were observed. Pain was reported by 19 of 22 patients, but 17 reported pain relief after implantation. Follow-up ranged 8–27 (median, 19) months. Tumor size was reduced in 11 patients within 1 month after surgery, nine patients showed no change, and tumor size increased in two patients. Finally, 1- and 2-year survival was 81.8 and 45.5%, respectively; 1- and 2-year local tumor control rates were 59.1 and 36.4%, respectively. Conclusions 125I seed implantation significantly reduced bone tumor size and relieved pain, with a low complication rate. These findings suggest that 125I brachytherapy treatment could be a useful palliative approach for pelvic bone tumor treatment.
Collapse
Affiliation(s)
- Chongren Wang
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Zhengqi Chen
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Wei Sun
- Orthopedic Oncology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China.,Shanghai Bone Tumor Institution, Shanghai, 201620, China
| | - Yisilamu Yasin
- Department of Spine Surgery, Xinjiang People's Hospital, Urumqi, Xinjiang Autonomous Region, 830001, China
| | - Chuanyin Zhang
- Department of Orthopedics, Huashan Hospital Baoshan Branch Affiliated to Fudan University, Shanghai, 200431, China
| | - Xiaojun Ma
- Orthopedic Oncology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China
| | - Jian Chen
- Orthopedic Oncology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China
| | - Jiakang Shen
- Orthopedic Oncology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China
| | - Yingqi Hua
- Orthopedic Oncology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China. .,Shanghai Bone Tumor Institution, Shanghai, 201620, China.
| | - Zhengdong Cai
- Orthopedic Oncology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China. .,Shanghai Bone Tumor Institution, Shanghai, 201620, China.
| |
Collapse
|
15
|
Eriguchi T, Yorozu A, Kuroiwa N, Yagi Y, Nishiyama T, Saito S, Toya K, Hanada T, Shiraishi Y, Ohashi T, Shigematsu N. Predictive factors for urinary toxicity after iodine-125 prostate brachytherapy with or without supplemental external beam radiotherapy. Brachytherapy 2016; 15:288-295. [PMID: 26924022 DOI: 10.1016/j.brachy.2015.12.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/20/2015] [Accepted: 12/21/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE We examined the factors associated with urinary toxicities because of brachytherapy with iodine-125 with or without supplemental external beam radiotherapy (EBRT) for prostate cancer. METHODS AND MATERIALS We investigated 1313 patients with localized prostate cancer treated with iodine-125 brachytherapy with or without supplemental EBRT between 2003 and 2009. The International Prostate Symptom Score (IPSS) and Common Terminology Criteria for Adverse Events data were prospectively determined. Patients, treatment, and implant factors were investigated for their association with urinary toxicity or symptoms. RESULTS IPSS resolution was not associated with biologically effective dose (BED). Baseline IPSS, total needles, and the minimal dose received by 30% of the urethra had the greatest effect according to multivariate analysis (MVA). Urinary symptom flare was associated with baseline IPSS, age, BED, and EBRT on MVA. Urinary symptom flare and urinary Grade 2 or higher (G2+) toxicity occurred in 51%, 58%, and 67% (p = 0.025) and 16%, 22%, and 20% (p = 0.497) of the <180, 180-220, and >220 Gy BED groups, respectively. Urinary G2+ toxicity was associated with baseline IPSS, neoadjuvant androgen deprivation therapy (NADT), and seed density on MVA. When we divided patients into four groups according to prostate volume (<30 cc or ≥30 cc) and NADT use, urinary G2+ toxicity was most commonly observed in those patients with larger prostates who received NADT, and least in the patients with smaller prostates and no NADT. CONCLUSIONS NADT was associated with urinary G2+ toxicity. Higher dose and supplemental EBRT did not appear to increase moderate to severe urinary toxicities or time to IPSS resolution; however, it influenced urinary symptom flare.
Collapse
Affiliation(s)
- Takahisa Eriguchi
- Department of Radiology, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, Japan; Department of Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
| | - Atsunori Yorozu
- Department of Radiology, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, Japan
| | - Nobuko Kuroiwa
- Department of Radiology, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, Japan
| | - Yasuto Yagi
- Department of Urology, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, Japan
| | - Toru Nishiyama
- Department of Urology, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, Japan
| | - Shiro Saito
- Department of Urology, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, Japan
| | - Kazuhito Toya
- Department of Urology, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, Japan; Department of Radiology, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo, Japan
| | - Takashi Hanada
- Department of Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yutaka Shiraishi
- Department of Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Toshio Ohashi
- Department of Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Naoyuki Shigematsu
- Department of Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| |
Collapse
|
16
|
Rana Z, Hong RL, Abugideiri M, McRae D, Cernica G, Mordkin R, Joel AB, Bernstein G, Nasr NM. Sexual, irritative, and voiding outcomes, following stereotactic body radiation therapy for prostate cancer. Radiat Oncol 2015; 10:182. [PMID: 26310244 PMCID: PMC4554301 DOI: 10.1186/s13014-015-0488-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 08/16/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Urinary symptoms and sexual dysfunction are the two most common complaints following prostate radiotherapy. The impact of hypofractionated treatment on sexual function, irritative symptoms, and voiding symptoms has not been determined within the same patient population. Here we present our institutional data on sexual function, voiding function, irritative symptoms, and treatment response following SBRT. METHODS This retrospective analysis includes 102 non-metastatic patients treated with SBRT at a single institution between May 2008 and September 2014. The course of radiotherapy consisted of 36.25 Gy (range 35-40) over five daily fractions. International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM), and PSA were recorded at baseline, 1, 3, 6, 9, 12, 18, 24, and 36 months after treatment. RESULTS Median patient age was 72 years old with a median follow-up of 4.3 years. Pretreatment IPSS-I score was 5.21, increasing to 6.97 (p < .001) after 1 month. The mean IPSS-I score returned close to baseline after 3 months to 5.86 and decreased to below baseline after 2 years to 5.09. At 3 months, 9 months, and 2 years, 47.5, 76.2, and 91.1% of patients had reached IPSS-I resolution. The mean IPSS-O score prior to treatment was 5.31 and there was an increase in the score to 6.45 (p = 0.344) at 1 month. The score remained close to baseline and decreased to 4.00 at 2 years and significantly decreased to 3.74 (p = 0.035) at 3 years. 64.4, 82.1, and 96.0% of patients had IPSS-O resolution by 3 months, 9 months, and 2 years. The mean SHIM score prior to treatment was 13.52 and continually decreased to below baseline a year after treatment to 10.56 (p < .001). SHIM score began to improve at 18 months, but was still significantly less than baseline at 12.12 (p = .01). CONCLUSIONS While an increase in AUA/IPSS score initially occurred, all patients resume normal activities immediately following treatment and the AUA/IPSS symptoms improved from baseline. Irittative symptoms take longer to resolve when compared to obstructive voiding symptoms in patients treated with SBRT. Three year PSA response, reported toxicity, erectile function preservation, and urinary function improvement, shows favorable results.
Collapse
Affiliation(s)
- Zaker Rana
- Department of Radiation Oncology Medicine, Virginia Hospital Center, 1701 N George Mason Dr, Arlington, VA 22205, USA.
| | - Robert L Hong
- Department of Radiation Oncology Medicine, Virginia Hospital Center, 1701 N George Mason Dr, Arlington, VA 22205, USA.
| | - Mustafa Abugideiri
- Department of Radiation Oncology Medicine, Virginia Hospital Center, 1701 N George Mason Dr, Arlington, VA 22205, USA.
| | - Donald McRae
- Department of Radiation Oncology Medicine, Virginia Hospital Center, 1701 N George Mason Dr, Arlington, VA 22205, USA.
| | - George Cernica
- Department of Radiation Oncology Medicine, Virginia Hospital Center, 1701 N George Mason Dr, Arlington, VA 22205, USA.
| | - Robert Mordkin
- Department of Radiation Oncology Medicine, Virginia Hospital Center, 1701 N George Mason Dr, Arlington, VA 22205, USA.
| | - Andrew B Joel
- Department of Radiation Oncology Medicine, Virginia Hospital Center, 1701 N George Mason Dr, Arlington, VA 22205, USA.
| | - Gregory Bernstein
- Department of Radiation Oncology Medicine, Virginia Hospital Center, 1701 N George Mason Dr, Arlington, VA 22205, USA.
| | - Nadim M Nasr
- Department of Radiation Oncology Medicine, Virginia Hospital Center, 1701 N George Mason Dr, Arlington, VA 22205, USA.
| |
Collapse
|
17
|
Kole TP, Tong M, Wu B, Lei S, Obayomi-Davies O, Chen LN, Suy S, Dritschilo A, Yorke E, Collins SP. Late urinary toxicity modeling after stereotactic body radiotherapy (SBRT) in the definitive treatment of localized prostate cancer. Acta Oncol 2015; 55:52-8. [PMID: 25972264 DOI: 10.3109/0284186x.2015.1037011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Late urinary symptom flare has been shown to occur in a small subset of men treated with ultra- hypofractionated stereotactic body radiotherapy (SBRT) for prostate cancer. The purpose of this study was to use normal tissue complication probability modeling in an effort to derive SBRT specific dosimetric predictor's of late urinary flare. MATERIAL AND METHODS Two hundred and sixteen men were treated for localized prostate cancer using ultra- hypofractionated SBRT. A dose of 35-36.25 Gy in 5 fractions was delivered to the prostate and proximal seminal vesicles. Functional surveys were conducted before and after treatment to assess late toxicity. Phenomenologic NTCP models were fit to bladder DVHs and late urinary flare outcomes using maximum likelihood estimation. RESULTS Twenty-nine patients experienced late urinary flare within two years of completion of treatment. Fitting of bladder DVH data to a Lyman NTCP model resulted in parameter estimates of m, TD50, and n of 0.19 (0-0.47), 38.7 Gy (31.1-46.4), and 0.13 (-0.14-0.41), respectively. Subsequent fit to a hottest volume probit model revealed a significant association of late urinary flare with dose to the hottest 12.7% of bladder volume. Multivariate analysis resulted in a final model that included patient age and hottest volume probit model predictions. Kaplan-Meier analysis demonstrated a two-year urinary flare free survival of 95.7% in patients 65 years or older with a bladder D12.7% of 33.5 Gy or less, compared to 74.5% in patients meeting none of these criteria. CONCLUSION NTCP modeling of late urinary flare after ultra-hypofractionated prostate SBRT demonstrates a relatively small volume effect for dose to the bladder, suggesting that reduction of volume receiving elevated dose will result in decreased incidence of late urinary toxicity. Future studies will be needed to examine the impact of dose to other potential sources of late genitourinary toxicity.
Collapse
Affiliation(s)
- Thomas P. Kole
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Michael Tong
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Binbin Wu
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | | | - Leonard N. Chen
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Anatoly Dritschilo
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Ellen Yorke
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Sean P. Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| |
Collapse
|
18
|
Zuber S, Weiß S, Baaske D, Schöpe M, Stevens S, Bodis S, Zwahlen DR. Iodine-125 seed brachytherapy for early stage prostate cancer: a single-institution review. Radiat Oncol 2015; 10:49. [PMID: 25880809 PMCID: PMC4349732 DOI: 10.1186/s13014-015-0349-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 02/02/2015] [Indexed: 12/17/2022] Open
Abstract
Purpose We are reporting the five-year biochemical control, toxicity profile and dosimetric parameters using iodine-125 low dose rate brachytherapy (BT) as monotherapy for early stage prostate cancer at a single institution. Material and methods Between April 2006 and December 2010, 169 men with early stage prostate cancer were treated with BT. Biochemical failure was defined using the Phoenix definition (nadir + 2 ng/mL). Treatment-related morbidities, including urinary, rectal and sexual function, were measured, applying the International Prostate Symptom Score (IPSS), the 7-grade Quality of Life Scale (QoL) and medical status, the International Consultation on Incontinence Modular Questionnaire (ICIQ), the International Index of Erectile Function (IIEF-5) and the Common Terminology Criteria for Adverse Events (CTCAE v4.03). Seed migration and loss, dosimetric parameters and learning effects were also analyzed. Results Medium follow-up time was 50 months (range, 1–85 months). The five-year biochemical failure rate was 7%. Acute proctitis rates were 19% (grade 1) and 1% (grade 2), respectively. The overall incidence of incontinence was 19% (mild), 16% (moderate) and < 1% (severe). An increase in IPSS ≥ 5 points was detected in 59% of patients, with 38% regaining their baseline. Seed dislocation was found in 24% of patients and correlated with D90 and V100. A learning curve was found for seed migration, D90 and V100. QoL correlated with the general health condition of patient, incontinence symptoms and IPSS. Conclusions BT for early stage prostate cancer offers excellent five-year biochemical control with low toxicities. QoL aspects are favorable. A learning curve was detected for procedural aspects but its impact on patient relevant endpoints remains inconclusive.
Collapse
Affiliation(s)
- Simon Zuber
- Klinikum Chemnitz gGmbH, Klinik für Radio-Onkologie, Flemmingstrasse 2, D-09116, Chemnitz, Germany. .,The London Clinic, 22 Devonshire Place, London, W1G 6JA, UK.
| | - Susan Weiß
- Klinikum Chemnitz gGmbH, Klinik für Radio-Onkologie, Flemmingstrasse 2, D-09116, Chemnitz, Germany.
| | - Dieter Baaske
- Klinikum Chemnitz gGmbH, Klinik für Radio-Onkologie, Flemmingstrasse 2, D-09116, Chemnitz, Germany.
| | - Michael Schöpe
- Klinikum Chemnitz gGmbH, Klinik für Radio-Onkologie, Flemmingstrasse 2, D-09116, Chemnitz, Germany.
| | - Simon Stevens
- The London Clinic, 22 Devonshire Place, London, W1G 6JA, UK.
| | - Stephan Bodis
- Kantonsspital Aarau AG, Tellstrasse 25/Postfach, CH-5001, Aaarau, Switzerland.
| | - Daniel R Zwahlen
- Kantonsspital Graubünden, Loëstrasse 170, CH-7000, Chur, Switzerland.
| |
Collapse
|
19
|
Janowski E, Chen LN, Kim JS, Lei S, Suy S, Collins B, Lynch J, Dritschilo A, Collins S. Stereotactic body radiation therapy (SBRT) for prostate cancer in men with large prostates (≥50 cm(3)). Radiat Oncol 2014; 9:241. [PMID: 25398516 PMCID: PMC4239322 DOI: 10.1186/s13014-014-0241-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 10/18/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Patients with large prostate volumes have been shown to have higher rates of genitourinary and gastrointestinal toxicities after conventional radiation therapy for prostate cancer. The efficacy and toxicity of stereotactic body radiation therapy (SBRT), which delivers fewer high-dose fractions of radiation treatment, is unknown for large prostate volume prostate cancer patients. We report our early experience using SBRT for localized prostate cancer in patients with large prostate volumes. METHODS 57 patients with prostate volumes ≥50 cm(3) prior to treatment with SBRT for localized prostate carcinoma and with a minimum follow up of two years were included in this retrospective review of prospectively collected data. Treatment was delivered using Cyberknife (Accuray) with doses of 35-36.25 Gy in 5 fractions. Biochemical control was assessed using the Phoenix definition. Toxicities were scored using the CTCAE v.4. Quality of life was assessed using the American Urological Association (AUA) Symptom Score and the Expanded Prostate Cancer Index Composite (EPIC)-26. RESULTS 57 patients (23 low-, 25 intermediate- and 9 high-risk according to the D'Amico classification) at a median age of 69 years (range, 54-83 years) received SBRT with a median follow-up of 2.9 years. The median prostate size was 62.9 cm(3) (range 50-138.7 cm(3)). 33.3% of patients received ADT. The median pre-treatment prostate-specific antigen (PSA) was 6.5 ng/ml and decreased to a median PSA of 0.4 ng/ml by 2 years (p <0.0001). A mean baseline AUA symptom score of 7.5 significantly increased to 13 at 1 month (p = 0.001) and returned to baseline by 3 months (p = 0.21). 23% of patients experienced a late transient urinary symptom flare in the first two years following treatment. Mean baseline EPIC bowel scores of 95.8 decreased to 78.1 at 1 month (p <0.0001), but subsequently improved to 93.5 three months (p = 0.08). The 2-year actuarial incidence rates of GU and GI toxicity ≥ grade 2 were 49.1% and 1.8%, respectively. Two patients (3.5%) experienced grade 3 urinary toxicity, and no patient experienced grade 3 gastrointestinal toxicity. CONCLUSIONS SBRT for clinically localized prostate cancer was well tolerated in men with large prostate volumes.
Collapse
Affiliation(s)
- Einsley Janowski
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Leonard N Chen
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Joy S Kim
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Brian Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - John Lynch
- Department of Urology, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Anatoly Dritschilo
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| | - Sean Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
| |
Collapse
|
20
|
Rana Z, Cyr RA, Chen LN, Kim BS, Moures RA, Yung TM, Lei S, Collins BT, Suy S, Dritschilo A, Lynch JH, Collins SP. Improved irritative voiding symptoms 3 years after stereotactic body radiation therapy for prostate cancer. Front Oncol 2014; 4:290. [PMID: 25374844 PMCID: PMC4204455 DOI: 10.3389/fonc.2014.00290] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/07/2014] [Indexed: 11/18/2022] Open
Abstract
Background: Irritative voiding symptoms are common in elderly men and following prostate radiotherapy. There is limited clinical data on the impact of hypofractionated treatment on irritative voiding symptoms. This study sought to evaluate urgency, frequency, and nocturia following stereotactic body radiation therapy (SBRT) for prostate cancer. Methods: Patients treated with SBRT monotherapy for localized prostate cancer from August 2007 to July 2011 at Georgetown University Hospital were included in this study. Treatment was delivered using the CyberKnife® with doses of 35–36.25 Gy in five fractions. Patient-reported urinary symptoms were assessed using the International Prostate Symptom Score (IPSS) before treatment and at 1, 3, 6, 9, and 12 months post-treatment and every 6 months thereafter. Results: Two hundred four patients at a median age of 69 years received SBRT with a median follow-up of 4.8 years. Prior to treatment, 50.0% of patients reported moderate to severe lower urinary tract symptoms (LUTS) and 17.7% felt that urinary frequency was a moderate to big problem. The mean prostate volume was 39 cc and 8% had prior procedures for benign prostatic hyperplasia. A mean baseline IPSS-irritative (IPSS-I) score of 4.8 significantly increased to 6.5 at 1 month (p < 0.0001), however returned to baseline at 3 months (p = 0.73). The IPSS-I score returned to baseline in 91% of patients by 6 months and 96% of patients by 2 years. Transient increases in irritative voiding symptoms were common at 1 year. The mean baseline IPSS-I score decreased to 4.4 at 24 months (p = 0.03) and 3.7 at 36 months (p < 0.0001). In men with moderate to severe LUTS (IPSS ≥ 8) at baseline, the mean IPSS-I decreased from a baseline score of 6.8–4.9 at 3 years post-SBRT. This decrease was both statistically (p < 0.0001) and clinically significant (minimally important difference = 1.45). Only 14.6% of patients felt that urinary frequency was a moderate to big problem at 3 years post-SBRT (p = 0.23). Conclusion: Treatment of prostate cancer with SBRT resulted in an acute increase in irritative urinary symptoms that peaked within the first month post-treatment. Irritative voiding symptoms returned to baseline in the majority of patients by 3 months post-SBRT and were actually improved from baseline at 3 years post-SBRT.
Collapse
Affiliation(s)
- Zaker Rana
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Robyn A Cyr
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Leonard N Chen
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Brian S Kim
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Rudy A Moures
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Thomas M Yung
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Brian T Collins
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Anatoly Dritschilo
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - John H Lynch
- Department of Urology, Georgetown University Hospital , Washington, DC , USA
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| |
Collapse
|
21
|
Collins SP, Suy S, Chen LN, Collins BT, Lynch J, Dritschilo A. Late Urinary Symptom Flare After Prostate Stereotactic Body Radiation Therapy. J Clin Oncol 2014; 32:3451-2. [DOI: 10.1200/jco.2014.56.6547] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Simeng Suy
- Georgetown University Hospital, Washington, DC
| | | | | | - John Lynch
- Georgetown University Hospital, Washington, DC
| | | |
Collapse
|
22
|
Arscott WT, Chen LN, Wilson N, Bhagat A, Kim JS, Moures RA, Yung TM, Lei S, Collins BT, Kowalczyk K, Suy S, Dritschilo A, Lynch JH, Collins SP. Obstructive voiding symptoms following stereotactic body radiation therapy for prostate cancer. Radiat Oncol 2014; 9:163. [PMID: 25056726 PMCID: PMC4118163 DOI: 10.1186/1748-717x-9-163] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 07/17/2014] [Indexed: 11/29/2022] Open
Abstract
Background Obstructive voiding symptoms (OVS) are common following prostate cancer treatment with radiation therapy. The risk of urinary retention (UR) following hypofractionated radiotherapy has yet to be fully elucidated. This study sought to evaluate OVS and UR requiring catheterization following SBRT for prostate cancer. Methods Patients treated with SBRT for localized prostate cancer from February 2008 to July 2011 at Georgetown University were included in this study. Treatment was delivered using the CyberKnife® with doses of 35 Gy-36.25 Gy in 5 fractions. UR was prospectively scored using the CTCAE v.3. Patient-reported OVS were assessed using the IPSS-obstructive subdomain at baseline and at 1, 3, 6, 9, 12, 18 and 24 months. Associated bother was evaluated via the EPIC-26. Results 269 patients at a median age of 69 years received SBRT with a median follow-up of 3 years. The mean prostate volume was 39 cc. Prior to treatment, 50.6% of patients reported moderate to severe lower urinary track symptoms per the IPSS and 6.7% felt that weak urine stream and/or incomplete emptying were a moderate to big problem. The 2-year actuarial incidence rates of acute and late UR ≥ grade 2 were 39.5% and 41.4%. Alpha-antagonist utilization rose at one month (58%) and 18 months (48%) post-treatment. However, Grade 3 UR was low with only 4 men (1.5%) requiring catheterization and/or TURP. A mean baseline IPSS-obstructive score of 3.6 significantly increased to 5.0 at 1 month (p < 0.0001); however, it returned to baseline in 92.6% within a median time of 3 months. Late increases in OVS were common, but transient. Only 7.1% of patients felt that weak urine stream and/or incomplete emptying was a moderate to big problem at two years post-SBRT (p = 0.6854). Conclusions SBRT treatment caused an acute increase in OVS which peaked within the first month post-treatment, though acute UR requiring catheterization was rare. OVS returned to baseline in > 90% of patients within a median time of three months. Transient Late increases in OVS were common. However, less than 10% of patients felt that OVS were a moderate to big problem at two years post-SBRT.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC 20007, USA.
| |
Collapse
|
23
|
Woo JA, Chen LN, Bhagat A, Oermann EK, Kim JS, Moures R, Yung T, Lei S, Collins BT, Kumar D, Suy S, Dritschilo A, Lynch JH, Collins SP. Clinical characteristics and management of late urinary symptom flare following stereotactic body radiation therapy for prostate cancer. Front Oncol 2014; 4:122. [PMID: 24904833 PMCID: PMC4033266 DOI: 10.3389/fonc.2014.00122] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/09/2014] [Indexed: 12/12/2022] Open
Abstract
Purpose: Stereotactic body radiation therapy (SBRT) is increasingly utilized as primary treatment for clinically localized prostate cancer. While acute post-SBRT urinary symptoms are well recognized, the late genitourinary toxicity of SBRT has not been fully described. Here, we characterize the clinical features of late urinary symptom flare and recommend conservative symptom management approaches that may alleviate the associated bother. Methods: Between February 2008 and August 2011, 216 men with clinically localized prostate cancer were treated definitively with SBRT at Georgetown University Hospital. Treatment was delivered using the CyberKnife with doses of 35–36.25 Gy in five fractions. The prevalence of each of five Common Terminology Criteria for Adverse Events (CTCAE) graded urinary toxicities was assessed at each follow-up visit. Medication usage was documented at each visit. Patient-reported urinary symptoms were assessed using the American Urological Association (AUA) symptom score and the Expanded Prostate Cancer Index Composite (EPIC)-26 at 1, 3, 6, 9, 12, 18, and 24 months. Late urinary symptom flare was defined as an increase in the AUA symptom score of ≥5 points above baseline with a degree of severity in the moderate to severe range (AUA symptom score ≥15). The relationship between the occurrence of flare and pre-treatment characteristics were examined. Results: For all patients, the AUA symptom score spiked transiently at 1 month post-SBRT. Of the 216 patients, 29 (13.4%) experienced a second transient increase in the AUA symptom score that met the criteria for late urinary symptom flare. Among flare patients, the median age was 66 years compared to 70 for those without flare (p = 0.007). In patients who experienced flare, CTCAE urinary toxicities including dysuria, frequency/urgency, and retention peaked at 9–18 months, and alpha-antagonist utilization increased at 1 month post-treatment, rose sharply at 12 months post-treatment, and peaked at 18 months (85%) before decreasing at 24 months. The EPIC urinary summary score of flare patients declined transiently at 1 month and experienced a second, more protracted decline between 6 and 18 months before returning to near baseline at 2-year post-SBRT. Statistically and clinically significant increases in patient-reported frequency, weak stream, and dysuria were seen at 12 months post-SBRT. Among flare patients, 42.9% felt that urination was a moderate to big problem at 12 months following SBRT. Conclusion: In this study, we characterize late urinary symptom flare following SBRT. Late urinary symptom flare is a constellation of symptoms including urinary frequency/urgency, weak stream, and dysuria that transiently occurs 6–18 months post-SBRT. Provision of appropriate anticipatory counseling and the maintenance of prophylactic alpha-antagonists may limit the bother associated with this syndrome.
Collapse
Affiliation(s)
- Jennifer A Woo
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Leonard N Chen
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Aditi Bhagat
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Eric K Oermann
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Joy S Kim
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Rudy Moures
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Thomas Yung
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Brian T Collins
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Deepak Kumar
- Cancer Research Laboratory, Department of Biology, University of the District of Columbia , Washington, DC , USA
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Anatoly Dritschilo
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - John H Lynch
- Department of Urology, Georgetown University Hospital , Washington, DC , USA
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| |
Collapse
|
24
|
Alpha 1-adrenoceptor blocker may improve not only voiding but also storage lower urinary tract symptoms caused by (125) I brachytherapy for prostate cancer. ISRN UROLOGY 2014; 2014:140654. [PMID: 25006516 PMCID: PMC4004040 DOI: 10.1155/2014/140654] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 03/02/2014] [Indexed: 01/10/2023]
Abstract
Purpose. To assess changes in lower urinary tract symptoms (LUTS) within 1 year after brachytherapy in patients receiving alpha 1-adrenoceptor antagonists. Methods. We retrospectively evaluated 116 patients who underwent 125I prostate brachytherapy in our institute. Seventy-one patients were treated with a combination of external beam radiation therapy and brachytherapy. Alpha 1-adrenoceptor antagonists were prescribed to all patients after brachytherapy. International Prostate Symptom Score (IPSS) forms and postvoid residual urine volume were recorded at all follow-up visits. Results. Forty-nine patients were given tamsulosin hydrochloride, 32 were given silodosin hydrochloride, and 35 were given naftopidil for up to 6 months after seed implantation. Patients given tamsulosin or naftopidil tended to show a higher peak IPSS and slower recovery to baseline values than those given silodosin. The patients given naftopidil showed an insufficient recovery in storage symptoms in naftopidil group in comparison with tamsulosin group at 3 months and with silodosin group at 6 and 9 months. Conclusions. In the management of LUT after brachytherapy, silodosin may provide a more favorable improvement. Silodosin and tamsulosin may have an advantage in improving not only voiding but also storage lower urinary tract symptoms after brachytherapy.
Collapse
|
25
|
Bhattasali O, Chen LN, Woo J, Park JW, Kim JS, Moures R, Yung T, Lei S, Collins BT, Kowalczyk K, Suy S, Dritschilo A, Lynch JH, Collins SP. Patient-reported outcomes following stereotactic body radiation therapy for clinically localized prostate cancer. Radiat Oncol 2014; 9:52. [PMID: 24512837 PMCID: PMC3931491 DOI: 10.1186/1748-717x-9-52] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 02/06/2014] [Indexed: 02/07/2023] Open
Abstract
Background Stereotactic body radiation therapy (SBRT) delivers high doses of radiation to the prostate while minimizing radiation to adjacent normal tissues. Large fraction sizes may increase the risk of functional decrements. Treatment-related bother may be more important to a patient than treatment-related dysfunction. This study reports on patient-reported outcomes following SBRT for clinically localized prostate cancer. Methods Between August 2007 and July 2011, 228 consecutive hormone-naïve patients with clinically localized prostate cancer were treated with 35–36.25 Gy SBRT delivered using the CyberKnife Radiosurgical System (Accuray) in 5 fractions. Quality of life was assessed using the American Urological Association Symptom Score (AUA) and the Expanded Prostate Cancer Index Composite (EPIC)-26. Urinary symptom flare was defined as an AUA score 15 or more with an increase of 5 or more points above baseline 6 months after treatment. Results 228 patients (88 low-, 126 intermediate- and 14 high-risk) at a median age of 69 (44–90) years received SBRT with a minimum follow-up of 24 months. EPIC urinary and bowel summary scores declined transiently at 1 month and experienced a second, more protracted decline between 9 months and 18 months before returning to near baseline 2 years post-SBRT. 14.5% of patients experienced late urinary symptom flare following treatment. Patients who experienced urinary symptom flare had poorer bowel quality of life following SBRT. EPIC scores for urinary bother declined transiently, first at 1 month and again at 12 months, before approaching pre-treatment scores by 2 years. Bowel bother showed a similar pattern, but the second decline was smaller and lasted 9 months to 18 months. EPIC sexual summary and bother scores progressively declined over the 2 years following SBRT without recovery. Conclusions In the first 2 years, the impact of SBRT on urination and defecation was minimal. Transient late increases in urinary and bowel dysfunction and bother were observed. However, urinary and bowel function and bother recovered to near baseline by 2 years post-SBRT. Sexual dysfunction and bother steadily increased following treatment without recovery. SBRT for clinically localized prostate cancer was well tolerated with treatment-related dysfunction and bother comparable to conventionally fractionated radiation therapy or brachytherapy.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N,W,, Washington, D,C 20007, USA.
| |
Collapse
|
26
|
Kerns SL, Stone NN, Stock RG, Rath L, Ostrer H, Rosenstein BS. A 2-Stage Genome-Wide Association Study to Identify Single Nucleotide Polymorphisms Associated with Development of Urinary Symptoms After Radiotherapy for Prostate Cancer. J Urol 2013; 190:102-8. [DOI: 10.1016/j.juro.2013.01.096] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Sarah L. Kerns
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York
- Departments of Pathology and Genetics, Albert Einstein College of Medicine, New York, New York
| | - Nelson N. Stone
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York
- Department of Urology, Mount Sinai School of Medicine, New York, New York
| | - Richard G. Stock
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York
| | - Lynda Rath
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York
| | - Harry Ostrer
- Departments of Pathology and Genetics, Albert Einstein College of Medicine, New York, New York
| | - Barry S. Rosenstein
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York
- Department of Dermatology and Preventive Medicine, Mount Sinai School of Medicine, New York, New York
- Department of Radiation Oncology, New York University School of Medicine, New York, New York
| |
Collapse
|
27
|
Chen LN, Suy S, Uhm S, Oermann EK, Ju AW, Chen V, Hanscom HN, Laing S, Kim JS, Lei S, Batipps GP, Kowalczyk K, Bandi G, Pahira J, McGeagh KG, Collins BT, Krishnan P, Dawson NA, Taylor KL, Dritschilo A, Lynch JH, Collins SP. Stereotactic body radiation therapy (SBRT) for clinically localized prostate cancer: the Georgetown University experience. Radiat Oncol 2013; 8:58. [PMID: 23497695 PMCID: PMC3610192 DOI: 10.1186/1748-717x-8-58] [Citation(s) in RCA: 201] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 02/25/2013] [Indexed: 12/13/2022] Open
Abstract
Background Stereotactic body radiation therapy (SBRT) delivers fewer high-dose fractions of radiation which may be radiobiologically favorable to conventional low-dose fractions commonly used for prostate cancer radiotherapy. We report our early experience using SBRT for localized prostate cancer. Methods Patients treated with SBRT from June 2008 to May 2010 at Georgetown University Hospital for localized prostate carcinoma, with or without the use of androgen deprivation therapy (ADT), were included in this retrospective review of data that was prospectively collected in an institutional database. Treatment was delivered using the CyberKnife® with doses of 35 Gy or 36.25 Gy in 5 fractions. Biochemical control was assessed using the Phoenix definition. Toxicities were recorded and scored using the CTCAE v.3. Quality of life was assessed before and after treatment using the Short Form-12 Health Survey (SF-12), the American Urological Association Symptom Score (AUA) and Sexual Health Inventory for Men (SHIM) questionnaires. Late urinary symptom flare was defined as an AUA score ≥ 15 with an increase of ≥ 5 points above baseline six months after the completion of SBRT. Results One hundred patients (37 low-, 55 intermediate- and 8 high-risk according to the D’Amico classification) at a median age of 69 years (range, 48–90 years) received SBRT, with 11 patients receiving ADT. The median pre-treatment prostate-specific antigen (PSA) was 6.2 ng/ml (range, 1.9-31.6 ng/ml) and the median follow-up was 2.3 years (range, 1.4-3.5 years). At 2 years, median PSA decreased to 0.49 ng/ml (range, 0.1-1.9 ng/ml). Benign PSA bounce occurred in 31% of patients. There was one biochemical failure in a high-risk patient, yielding a two-year actuarial biochemical relapse free survival of 99%. The 2-year actuarial incidence rates of GI and GU toxicity ≥ grade 2 were 1% and 31%, respectively. A median baseline AUA symptom score of 8 significantly increased to 11 at 1 month (p = 0.001), however returned to baseline at 3 months (p = 0.60). Twenty one percent of patients experienced a late transient urinary symptom flare in the first two years following treatment. Of patients who were sexually potent prior to treatment, 79% maintained potency at 2 years post-treatment. Conclusions SBRT for clinically localized prostate cancer was well tolerated, with an early biochemical response similar to other radiation therapy treatments. Benign PSA bounces were common. Late GI and GU toxicity rates were comparable to conventionally fractionated radiation therapy and brachytherapy. Late urinary symptom flares were observed but the majority resolved with conservative management. A high percentage of men who were potent prior to treatment remained potent two years following treatment.
Collapse
Affiliation(s)
- Leonard N Chen
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC 20007, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Satoh T. Editorial Comment from Dr Satoh to Interpreting a rising prostate-specific antigen after brachytherapy for prostate cancer. Int J Urol 2013; 20:149. [DOI: 10.1111/j.1442-2042.2012.03138.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
29
|
Meyer A, Wassermann J, Warszawski-Baumann A, Baumann R, Machtens S, Karstens JH, Christiansen H, Merseburger A, Kuczyk MA, von Klot C. Segmental dosimetry, toxicity and long-term outcome in patients with prostate cancer treated with permanent seed implants. BJU Int 2013; 111:897-904. [PMID: 23305079 DOI: 10.1111/j.1464-410x.2012.11558.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: The development of side effects characteristic for the different treatment methods with impact on the patients' quality of life plays a growing role for individual patients with early stage prostate cancer. Using permanent brachytherapy a high dose to the prostate can be applied with a steep dose gradient to the normal tissue. However, small partial volumes of normal tissue may be exposed to high doses inducing special side effects including lower urinary tract symptoms and/or erectile dysfunction. In the literature there are only few publications so far regarding segmental dosimetry and its influence on side effects and the results are conflicting. We could not identify any dosimetric parameter in segmental dosimetry that may have an influence at certain time intervals on the development of side effects such as lower urinary tract symptoms or erectile dysfunction. However, we could state clearly that the preoperative situation is the most important factor for postoperative outcome. OBJECTIVE To report on the side effects of patients with low to low-intermediate risk prostate cancer treated with permanent interstitial brachytherapy with special emphasis on segmental dosimetry. PATIENTS AND METHODS A series of 186 consecutive patients treated for early stage prostate cancer receiving definitive I-125 brachytherapy (permanent seed implantation) between November 2001 and April 2005 at our institution were examined for the development of side effects. Morbidity was assessed prospectively using the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF-5) in a mean follow-up interval of 30 months. The scores were correlated with segmental dosimetry performed 6 weeks after the implantation. RESULTS The mean postoperative dose to 90% of the prostate volume (D90) was 180.2 Gy, the mean preoperative IPSS 7.2 and the mean IIEF-5 14.35, with all scores showing a maximum deterioration after 6 weeks with normalization after 24 months. After correlating the segmental dosimetry and the scores at different time intervals, only the baseline scores remained statistically significant in multivariate regression analysis at all time intervals (P < 0.00). CONCLUSIONS We could not demonstrate a correlation of segmental dosimetry with induction of side effects. There is no relationship between dose exposure of partial volumes and the development of radiation-induced toxicities. The preoperative situation regarding lower urinary tract symptoms and erectile function are the most important factors for postoperative outcome.
Collapse
Affiliation(s)
- Andreas Meyer
- Clinic of Radiation Oncology, Hannover Medical School, Hannover, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Ren Y, Bu R, Zhang L, Huang X, Li Y. Implantation of radioactive particles into the cranial base and orbital apex with the use of a magnetic resonance imaging-based surgical navigation system. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 116:e473-7. [PMID: 22858017 DOI: 10.1016/j.oooo.2012.01.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 12/25/2011] [Accepted: 01/26/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was try to find a new way with high precision to implant (125)I-radioactive particles for safe and effective control of tumors that have invaded into the cranial base and orbital regions. STUDY DESIGN Eight patients with invasive adenoid cystic carcinoma of the cranial base and orbital apex and a history of multiple surgeries were selected. A preoperative magnetic resonance scan was performed and the Brainlab surgical navigation system was used to aid the surgery. RESULTS The radioactive particles were distributed evenly within the tissue and accurately positioned. No intracranial injury or visual impairment occurred, and the treatment was effective. CONCLUSIONS The implantation of radioactive particles with the use of magnetic resonance imaging guidance is an effective and safe method for treating invasive malignancies of the skull base and orbital apex, and it should be considered for conditional use.
Collapse
Affiliation(s)
- Yipeng Ren
- Department of Oral and Maxillofacial Surgery, Chinese PLA General Hospital, Beijing, China
| | | | | | | | | |
Collapse
|
31
|
Carl J, Nielsen J, Holmberg M, Larsen EH, Fabrin K, Fisker RV. Clinical results from first use of prostate stent as fiducial for radiotherapy of prostate cancer. Acta Oncol 2011; 50:547-54. [PMID: 21174520 DOI: 10.3109/0284186x.2010.541935] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE A clinical feasibility study using a removable prostate stent as fiducial for image-guided radiotherapy (IGRT) of localized prostate cancer (PC). MATERIAL AND METHODS The study included patients with local or locally advanced PC. The clinical target volume (CTV) was outlined on magnetic resonance (MR) images co-registered to planning computer tomography (CT) images. Daily online IGRT was delivered using the stent as fiducial. Risk of migration was estimated using multiple MR. Acute urinary toxicity was scored using the international prostate symptom score (IPSS). Late gastro-intestinal (GI) and genito-urinary (GU) toxicity was scored using the Radio Therapy Oncology Group (RTOG) score, biochemical failure (BF) was defined as an elevation of prostate specific antigen (PSA) above nadir plus 2 ng/ml after radiotherapy. RESULTS One hundred men were enrolled in the study. Ninety completed radiotherapy with the stent as fiducial. No migration of the stent was seen, but three cases of dislocation of the stent to the bladder were observed. Acute urinary toxicity based on IPSS was comparable to toxicity in patients who had gold markers (GM) as fiducials. Removal of the stent was associated with a high frequency of urinary retention. Late GI and GU toxicity and BF were comparable to those of other studies, but longer observation time is needed. CONCLUSIONS This study reports the first clinical results of using a prostate stent as fiducial. No migration of the stent observed. Dislocation of the stent to the urinary bladder was observed in three cases, requiring removal of the stent and insertion of a new fiducial. Acute toxicity during radiotherapy evaluated from IPSS was comparable to toxicity in patients with GM. Removal of the stent was associated with a high frequency of post procedural urinary retention. Late toxicity and BF were comparable to those of other studies, though longer observation time is needed.
Collapse
Affiliation(s)
- Jesper Carl
- Department of Medical Physics, Department of Oncology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
| | | | | | | | | | | |
Collapse
|
32
|
Zilli T, Taussky D, Donath D, Le HP, Larouche RX, Béliveau-Nadeau D, Hervieux Y, Delouya G. Urethra-sparing, intraoperative, real-time planned, permanent-seed prostate brachytherapy: toxicity analysis. Int J Radiat Oncol Biol Phys 2011; 81:e377-83. [PMID: 21514068 DOI: 10.1016/j.ijrobp.2011.02.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 12/28/2010] [Accepted: 02/11/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To report the toxicity outcome in patients with localized prostate cancer undergoing (125)I permanent-seed brachytherapy (BT) according to a urethra-sparing, intraoperative (IO), real-time planned conformal technique. METHODS AND MATERIALS Data were analyzed on 250 patients treated consecutively for low- or intermediate-risk prostate cancer between 2005 and 2009. The planned goal was urethral V(150) = 0. Acute and late genitourinary (GU), gastrointestinal (GI), and erectile toxicities were scored with the International Prostate Symptom Score (IPSS) questionnaire and Common Terminology Criteria for Adverse Events (version 3.0). Median follow-up time for patients with at least 2 years of follow-up (n = 130) was 34.4 months (range, 24-56.9 months). RESULTS Mean IO urethra V(150) was 0.018% ± 0.08%. Mean prostate D(90) and V(100) on day-30 computed tomography scan were 158.0 ± 27.0 Gy and 92.1% ± 7.2%, respectively. Mean IPSS peak was 9.5 ± 6.3 1 month after BT (mean difference from baseline IPSS, 5.3). No acute GI toxicity was observed in 86.8% of patients. The 3-year probability of Grade ≥2 late GU toxicity-free survival was 77.4% ± 4.0%, with Grade 3 late GU toxicity encountered in only 3 patients. Three-year Grade 1 late GI toxicity-free survival was 86.1% ± 3.2%. No patient presented Grade ≥2 late GI toxicity. Of patients with normal sexual status at baseline, 20.7% manifested Grade ≥2 erectile dysfunction after BT. On multivariate analysis, elevated baseline IPSS (p = 0.016) and high-activity sources (median 0.61 mCi) (p = 0.033) predicted increased Grade ≥2 late GU toxicity. CONCLUSIONS Urethra-sparing IO BT results in low acute and late GU toxicity compared with the literature. High seed activity and elevated IPSS at baseline increased long-term GU toxicity.
Collapse
Affiliation(s)
- Thomas Zilli
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal-Hôpital Notre-Dame, Montréal, QC, Canada
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Malik R, Jani AB, Liauw SL. External beam radiotherapy for prostate cancer: urinary outcomes for men with high International Prostate Symptom Scores (IPSS). Int J Radiat Oncol Biol Phys 2010; 80:1080-6. [PMID: 20643513 DOI: 10.1016/j.ijrobp.2010.03.040] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 03/08/2010] [Accepted: 03/31/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To report the urinary outcome of men treated for prostate cancer with external beam radiotherapy (EBRT) who have pretreatment obstructive urinary symptoms (International Prostate Symptom Score [IPSS] ≥ 15). METHODS AND MATERIALS We treated 368 patients with EBRT for localized prostate cancer, and pre- and post-radiotherapy (RT) IPSSs were recorded. In total, 80 men had an IPSS ≥ 15, 48% of whom were taking genitourinary (GU) medications before RT. The IPSS was followed over time and analyzed as a pretreatment factor against Radiation Therapy Oncology Group acute and late GU toxicity. RESULTS The median follow-up was 44 months. Among men with a pre-RT IPSS ≥ 15, the median IPSS at baseline, first follow-up, and last follow-up was 18 (range, 15 to 34), 17 (range, 0 to 32), and 13 (range, 0 to 34), respectively. The mean patient declines in IPSS from baseline to first and last follow-up were -3.6 points (p < 0.0004) and -6.9 points (p < 0.0001), respectively. At last follow-up, 43 men (54%) took GU medications. Pre-RT IPSS ≥ 15 vs. ≤ 14 was associated with a higher incidence of Grade ≥ 2 acute GU toxicity (64% vs. 42%, p = 0.0005), and 4-year freedom from Grade ≥ 2 late GU toxicity was 38% vs. 64% (p < 0.0001). There was no greatly increased risk of Grade ≥ 3 late GU toxicity for men with IPSS ≥ 15 (4-year freedom from Grade ≥ 3 late GU toxicity of 90% vs. 96%, p = 0.0964). CONCLUSIONS Although the improvement is not immediate, men with moderate to severe obstructive GU symptoms can have improvement in urinary function after EBRT, without significant risk for severe morbidity.
Collapse
Affiliation(s)
- Renuka Malik
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL 60637, USA
| | | | | |
Collapse
|
34
|
Curiethérapie de prostate par iode 125 : facteurs pronostiques de longue durée de toxicité urinaire, digestive et sexuelle. Cancer Radiother 2009; 13:721-30. [DOI: 10.1016/j.canrad.2009.08.144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Revised: 07/22/2009] [Accepted: 08/06/2009] [Indexed: 11/17/2022]
|
35
|
Tanaka N, Fujimoto K, Hirao Y, Asakawa I, Hasegawa M, Konishi N. Variations in International Prostate Symptom Scores, Uroflowmetric Parameters, and Prostate Volume After 125I Permanent Brachytherapy for Localized Prostate Cancer. Urology 2009; 74:407-11. [DOI: 10.1016/j.urology.2008.12.062] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 11/26/2008] [Accepted: 12/01/2008] [Indexed: 11/30/2022]
|
36
|
Gore JL, Kwan L, Lee SP, Reiter RE, Litwin MS. Survivorship beyond convalescence: 48-month quality-of-life outcomes after treatment for localized prostate cancer. J Natl Cancer Inst 2009; 101:888-92. [PMID: 19509365 DOI: 10.1093/jnci/djp114] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Decision making for treatment of localized prostate cancer is often guided by therapeutic side-effect profiles. We sought to assess health-related quality-of-life outcomes for patients 48 months after treatment for localized prostate cancer. Men treated for localized prostate cancer (N = 475) were evaluated before treatment and at 11 intervals during the 48 months after intervention. Changes in mean health-related quality-of-life scores and the probability of regaining baseline levels of health-related quality of life were compared between treatment groups. All statistical tests were two-sided. Urinary incontinence was more common after prostatectomy (n = 307) than after brachytherapy (n = 90) or external beam radiation therapy (n = 78) (both P < .001), whereas voiding and storage urinary symptoms were more prevalent after brachytherapy than after prostatectomy (both P < .001). Sexual dysfunction profoundly affected all three treatment groups, with a lower likelihood of regaining baseline function after prostatectomy than after external beam radiation therapy or brachytherapy (P < .001). Bowel dysfunction was more common after either form of radiation therapy than after prostatectomy. These results may guide decision making for treatment selection and clinical management of patients with health-related quality-of-life impairments after treatment for localized prostate cancer.
Collapse
Affiliation(s)
- John L Gore
- Robert Wood Johnson Clinical Scholars Program, University of California, Los Angeles, 911 Broxton Avenue, Los Angeles, CA 90024, USA.
| | | | | | | | | |
Collapse
|
37
|
Caloglu M, Ciezki J. Prostate-specific antigen bounce after prostate brachytherapy: review of a confusing phenomenon. Urology 2009; 74:1183-90. [PMID: 19428077 DOI: 10.1016/j.urology.2009.01.043] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 01/21/2009] [Accepted: 01/21/2009] [Indexed: 11/19/2022]
Abstract
Prostate brachytherapy is a commonly used modality for the treatment of prostate cancer. After prostate brachytherapy, the prostate-specific antigen (PSA) level may fluctuate and increase temporarily without a clear reason in 30-40% of successfully treated men. This phenomenon is called "PSA bounce" and engenders anxiety on the part of the patient and physician. Having reviewed the literature we found 19 articles and summarized in the current review to delineate the facts of this relatively common and ambiguous phenomenon. Although several patient and treatment related factors were assessed by studies, only age remained as the most consistent predictor.
Collapse
Affiliation(s)
- Murat Caloglu
- Department of Radiation Oncology, Trakya University Faculty of Medicine, Edirne, Turkey.
| | | |
Collapse
|
38
|
Mols F, Stijns P, Dankaart B, Houterman S, Vingerhoets A, Hendrikx A. Health-Related Quality of Life in I-125 Prostate Brachytherapy Patients Treated with and without Volume-Reducing Hormone Therapy: Results of a Short-Term Prospective Study. J Endourol 2009; 23:153-9. [DOI: 10.1089/end.2008.0089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Floortje Mols
- CoRPS—Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
- Comprehensive Cancer Centre South (CCCS), Eindhoven Cancer Registry, Eindhoven, The Netherlands
| | - Pascal Stijns
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | - Bram Dankaart
- CoRPS—Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - Saskia Houterman
- Comprehensive Cancer Centre South (CCCS), Eindhoven Cancer Registry, Eindhoven, The Netherlands
- MMC Academy, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Ad Vingerhoets
- Clinical Psychology Section, Tilburg University, Tilburg, The Netherlands
| | - Ad Hendrikx
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| |
Collapse
|
39
|
Satoh T, Ishiyama H, Matsumoto K, Tsumura H, Kitano M, Hayakawa K, Ebara S, Nasu Y, Kumon H, Kanazawa S, Miki K, Egawa S, Aoki M, Toya K, Yorozu A, Nagata H, Saito S, Baba S. Prostate-specific antigen 'bounce' after permanent 125I-implant brachytherapy in Japanese men: a multi-institutional pooled analysis. BJU Int 2008; 103:1064-8. [PMID: 19040526 DOI: 10.1111/j.1464-410x.2008.08234.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the incidence, timing, and magnitude of the prostate-specific antigen (PSA) level 'bounce' after permanent prostate brachytherapy (BT) and correlate the PSA bounce with clinical and dosimetric factors in Japanese patients with prostate cancer. PATIENTS AND METHODS A multi-institutional pooled analysis was carried out in 388 consecutive patients with T1-T2N0M0 prostate cancer treated with (125)I-seed implant BT with no hormonal therapy or external beam radiotherapy. All patients had >or=1 year of follow-up and at least three follow-up PSA level measurements. Three definitions of PSA bounce were used: definition A, a PSA level rise of 0.1 ng/mL; definition B, a PSA level rise of 0.4 ng/mL; and definition C, a PSA level rise of 35% over the previous value, followed by a subsequent fall. RESULTS The actuarial likelihood of having PSA bounce at 24 months was 50.8% for definition A, 23.5% for definition B, and 19.4% for definition C. The median time to develop PSA bounce was 12 months for definition A, 18 months for definition B, and 18 months for definition C. There was a PSA bounce magnitude of 2 ng/mL in 5.3% of patients, and 95.3% of PSA bounce occurred within 24 months after (125)I-BT. Among the before and after (125)I-BT factors, clinical stage, initial PSA level, and Gleason score did not predict for PSA bounce using any definition; only being younger predicted for PSA bounce on multivariate analysis (P < 0.001). CONCLUSIONS PSA bounce is a common phenomenon after (125)I-BT and occurred at a rate of 19-51% in the Japanese men who underwent (125)I-BT, depending on the definition used. It is more common in younger patients, and early PSA bounce should be considered when assessing a patient with a rising PSA level after (125)I-BT, before implementing salvage interventions. Furthermore, PSA bounce magnitude might be lower in Japanese than in Caucasian patients.
Collapse
Affiliation(s)
- Takefumi Satoh
- Department of Urology, Kitasato University School of Medicine, Kangawa, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Thomas C, Keyes M, Liu M, Moravan V. Segmental Urethral Dosimetry and Urinary Toxicity in Patients With No Urinary Symptoms Before Permanent Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2008; 72:447-55. [DOI: 10.1016/j.ijrobp.2007.12.052] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Revised: 12/14/2007] [Accepted: 12/18/2007] [Indexed: 11/28/2022]
|
41
|
Steggerda MJ, van der Poel HG, Moonen LM. An analysis of the relation between physical characteristics of prostate I-125 seed implants and lower urinary tract symptoms: Bladder hotspot dose and prostate size are significant predictors. Radiother Oncol 2008; 88:108-14. [DOI: 10.1016/j.radonc.2007.10.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Revised: 10/12/2007] [Accepted: 10/23/2007] [Indexed: 10/22/2022]
|
42
|
Michaelson MD, Cotter SE, Gargollo PC, Zietman AL, Dahl DM, Smith MR. Management of complications of prostate cancer treatment. CA Cancer J Clin 2008; 58:196-213. [PMID: 18502900 PMCID: PMC2900775 DOI: 10.3322/ca.2008.0002] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Prostate cancer is the most commonly diagnosed noncutaneous cancer in men in the United States. Treatment of men with prostate cancer commonly involves surgical, radiation, or hormone therapy. Most men with prostate cancer live for many years after diagnosis and may never suffer morbidity or mortality attributable to prostate cancer. The short-term and long-term adverse consequences of therapy are, therefore, of great importance. Adverse effects of radical prostatectomy include immediate postoperative complications and long-term urinary and sexual complications. External beam or interstitial radiation therapy in men with localized prostate cancer may lead to urinary, gastrointestinal, and sexual complications. Improvements in surgical and radiation techniques have reduced the incidence of many of these complications. Hormone treatment typically consists of androgen deprivation therapy, and consequences of such therapy may include vasomotor flushing, anemia, and bone density loss. Numerous clinical trials have studied the role of bone antiresorptive therapy for prevention of bone density loss and fractures. Other long-term consequences of androgen deprivation therapy may include adverse body composition changes and increased risk of insulin resistance, diabetes, and cardiovascular disease. Ongoing and planned clinical trials will continue to address strategies to prevent treatment-related side effects and improve quality of life for men with prostate cancer.
Collapse
Affiliation(s)
- M Dror Michaelson
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | | | | |
Collapse
|
43
|
Song Y, Chan MF, Burman C, Cann D. Comparison of two treatment approaches for prostate cancer: intensity-modulated radiation therapy combined with 125I seed-implant brachytherapy or 125I seed-implant brachytherapy alone. J Appl Clin Med Phys 2008; 9:1-14. [PMID: 18714275 PMCID: PMC5721712 DOI: 10.1120/jacmp.v9i2.2283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Revised: 01/15/2007] [Accepted: 01/03/2008] [Indexed: 11/23/2022] Open
Abstract
The purpose of the present study was to assess the results of two different treatment approaches for clinically localized prostate cancer: intensity‐modulated radiation therapy (IMRT) followed by I125 seed‐implant brachytherapy and I125 seed‐implant brachytherapy alone. We studied our 30 most recent consecutive patients. The sample population consisted of 15 cases treated with IMRT (50.4 Gy) followed by I125 seed‐implant boost (95 Gy), and 15 cases treated with I125 seed implant only (144 Gy). We analyzed established dosimetric indices and various clinical parameters. In addition, we also evaluated and compared the acute urinary morbidities of the two treatment approaches, as assessed by the international prostate symptom score (IPSS). In our series, acute urinary morbidity was slightly increased with IMRT followed by I125 seed‐implant brachytherapy as compared with I125 seed‐implant brachytherapy alone. In addition, we observed no statistically significant correlation between the IPSS and the maximum or mean urethral dose. The combination of IMRT and seed‐implant brachytherapy presents an alternative opportunity to treat clinically localized prostate cancer. The full potential of the procedure needs to be further investigated. PACS number: 87.53.Tf
Collapse
Affiliation(s)
- Yulin Song
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, Dover, New Jersey, U.S.A
| | - Maria F Chan
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, Dover, New Jersey, U.S.A
| | - Chandra Burman
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, Dover, New Jersey, U.S.A
| | - Donald Cann
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, Dover, New Jersey, U.S.A
| |
Collapse
|
44
|
Crook J, Fleshner N, Roberts C, Pond G. Long-term urinary sequelae following 125iodine prostate brachytherapy. J Urol 2007; 179:141-5; discussion 146. [PMID: 17997424 DOI: 10.1016/j.juro.2007.08.136] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Indexed: 11/27/2022]
Abstract
PURPOSE We describe long-term urinary function in men treated with 125iodine brachytherapy without supplemental beam irradiation. MATERIALS AND METHODS A total of 484 men with favorable risk prostate cancer received 125I prostate brachytherapy with a followup ranging from 12 to 93 months (median 41). Prior hormonal therapy (2 to 6 months) was used in 14% of patients to reduce prostate size. Urinary function was assessed before implant by the International Prostate Symptom Score and a voiding study, and in followup by International Prostate Symptom Score. Urinary retention and catheterization, urgency and urge incontinence, persistently increased International Prostate Symptom Score, stricture, and the need for surgical intervention are reported. RESULTS Beyond 1 year 73.3% of men had no significant urinary sequelae. A flare in the International Prostate Symptom Score to greater than 15 and at least 5 points above baseline occurred in 23%, lasting a median of 3 months. Symptoms of retention requiring catheterization or surgical intervention were seen in 3.4% (1.7% stricture, 0.4% transurethral resection of the prostate, 2.7% catheter). Of the 13 men requiring catheterization at any time after 1 year, 5 (1% of total) remain dependent on clean intermittent catheterization. Median duration of catheter use for those with resolution is 4.5 months. Moderate to severe urinary urgency occurred in 6.4% of patients but it was unresponsive to anticholinergics in only 0.8%. CONCLUSIONS In this group 27% of men experienced late urinary morbidity following 125I prostate brachytherapy. Rates may vary according to technique and selection factors. The majority responded well to medical or surgical intervention, with 0.8% persistent urgency, and 1% catheter dependence.
Collapse
Affiliation(s)
- Juanita Crook
- Department of Radiation Oncology, University Health Network, Princess Margaret Hospital, Toronto, Ontario, Canada
| | | | | | | |
Collapse
|
45
|
Cesaretti JA, Stone NN, Skouteris VM, Park JL, Stock RG. Brachytherapy for the Treatment of Prostate Cancer. Cancer J 2007; 13:302-12. [DOI: 10.1097/ppo.0b013e318156dcbe] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
46
|
Trojan L, Harrer K, Schäfer J, Voss M, Welzel G, Bolenz C, Wenz F, Alken P, Michel MS. Komplikationen und Nebenwirkungen der LDR-Brachytherapie beim Prostatakarzinom. Urologe A 2007; 46:1542-7. [PMID: 17622506 DOI: 10.1007/s00120-007-1369-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Brachytherapy (BT) is an established treatment option for low risk prostate cancer. The aim of this study was to determine the long-term complications and side effects of the procedure in an up to 13 year long single center follow-up analysis. MATERIAL A total of 505 patients were treated by BT for prostate cancer between May 1991 and August 2005. Cohort I (n=412; May 1991 to November 2003) was evaluated by written questionnaire (modified ICS male) and patient chart evaluation in terms of side effects and secondary interventions. In cohort II (n=148; January 2002 to August 2005) perioperative complications were investigated. RESULTS The mean follow-up was 5.5 years. Perioperative complications were present in 5.4% of patients. Transurethral resection of the prostate was a common secondary intervention, performed in 7% of cases. The rate of incontinence was 6.3% in the long-term follow-up, the rate of potency was 43.5% in those patients who were potent before BT and no hormonal manipulation was performed at any time. CONCLUSION BT is a minimally invasive procedure for the treatment of localised "low risk" prostate cancer. Perioperative complications are rare, secondary intervention may be necessary and the patient has to be informed of possible impotence, incontinence and lack of ejaculation.
Collapse
Affiliation(s)
- L Trojan
- Urologische Klinik, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Matthew AG, Currie KL, Irvine J, Ritvo P, Santa Mina D, Jamnicky L, Nam R, Trachtenberg J. Serial personal digital assistant data capture of health-related quality of life: a randomized controlled trial in a prostate cancer clinic. Health Qual Life Outcomes 2007; 5:38. [PMID: 17617906 PMCID: PMC1936985 DOI: 10.1186/1477-7525-5-38] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Accepted: 07/06/2007] [Indexed: 11/24/2022] Open
Abstract
Background In clinical and research practice linked to prostate cancer treatment, frequent monitoring of patient health-related quality of life (HRQOL) is essential. Practical and analytic limitations of paper questionnaire data capture may be overcome with the use of self-administered personal digital assistant (PDA) data collection. The objective of this study was to assess the reliability, validity, and feasibility of using PDA in place of paper versions of the International Prostate Symptom Score (IPSS), the Patient Oriented Prostate Cancer Utility Survey (PORPUS), and the International Index of Erectile Function-5 (IIEF-5) in a prostate cancer clinic setting. Methods 152 participants were randomly assigned to one of three conditions: 1) paper followed by PDA survey; 2) PDA followed by paper survey; or 3) PDA followed by PDA survey. Evaluation included an assessment of data quality (internal consistency, test-retest reliability, response correlation, completeness of data), and feasibility (participation rates, time to completion, preference and difficultly/ease of using PDA). Results Internal consistency was similar for both PDA and paper applications. Test-retest reliability was confirmed for PDA repeated administration. Data from paper and PDA questionnaires were strongly correlated. Lower missed item rates were found in PDA administration. 82.8% of participants preferred using the PDA or had no preference. Mean difficulty/ease ratings indicated that participants found the PDA easy to use. Age did not significantly correlate with preference or difficulty. Conclusion The results confirm the adaptability of the IPSS, IIEF-5, and the PORPUS to PDA administration. Similarly, the findings of this study support the feasibility of using PDA technology for HRQOL serial data capture in the prostate cancer patient population.
Collapse
Affiliation(s)
- Andrew G Matthew
- Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kristen L Currie
- Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Jane Irvine
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, York University, 4700 Keele St, Toronto, Ontario M3J 1P3, Canada
| | - Paul Ritvo
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- School of Kinesiology & Health Science, York University, 4700 Keele St, Toronto, Ontario M3J 1P3, Canada
- Division of Preventive Oncology, Cancer Care Ontario, 620 University Avenue, Toronto, Ontario, M5G 2M9, Canada
| | - Daniel Santa Mina
- Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Leah Jamnicky
- Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Robert Nam
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Divisions of Urology and Surgical Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - John Trachtenberg
- Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
48
|
Bratt O. The urologist's guide to low dose-rate interstitial brachytherapy with permanent seed implants for localized prostate cancer. BJU Int 2007; 99:497-501. [PMID: 17092283 DOI: 10.1111/j.1464-410x.2006.06587.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ola Bratt
- Department of Urology, University Hospital Lund, SE-221 85 Lund, Sweden.
| |
Collapse
|
49
|
Stone NN, Stock RG. Long-Term Urinary, Sexual, and Rectal Morbidity in Patients Treated with Iodine-125 Prostate Brachytherapy Followed Up for a Minimum of 5 Years. Urology 2007; 69:338-42. [PMID: 17320674 DOI: 10.1016/j.urology.2006.10.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2006] [Revised: 08/23/2006] [Accepted: 10/04/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To define the long-term morbidity in patients with prostate cancer who underwent iodine-125 brachytherapy. METHODS A total of 325 men with localized prostate cancer treated with iodine-125 brachytherapy had a median follow-up of 7 years (range 5 to 15). The American Urological Association symptom score, erectile function status, rectal bleeding incidence, and presence of urinary incontinence were collected prospectively before implantation and every 6 months thereafter. Comparisons were made between the pretreatment and treatment-related factors and their associations with quality-of-life changes. Associations were tested using the Student t, chi-square, and Wilcoxon signed rank tests. RESULTS The median prostate volume and maximal dose to 90% of the prostate was 36.6 cm3 and 167 Gy, respectively. Of the 325 men, 15.7% experienced prostate-specific antigen failure and 4% started androgen deprivation therapy. The mean total symptom and bother scores increased from baseline (P <0.001) to 6 months after implantation, steadily decreased, and were unchanged at the last follow-up visit (P = 0.6). There were no significant associations among patient age, race, hormonal therapy use, prostate size, radiation dose, and urinary morbidity. Incontinence occurred in 4 (1.2%) of the 325 patients at the last follow-up visit and was associated with transurethral resection of the prostate (odds ratio 8.8, 95% confidence interval 1.3 to 62, P = 0.008). Before implantation, 77.2% were able to have an erection adequate for intercourse and 50.6% were able to at the last follow-up visit. A significant correlation was found between potency preservation and age (P <0.001). Rectal bleeding occurred in 78 men (24%) 1 to 3 years after implantation. Nine patients (2.8%) complained of minor bleeding beyond 5 years, which was associated with greater radiation doses (P = 0.023). CONCLUSIONS The preservation of urinary, sexual, and rectal quality of life is excellent at long follow-up for patients implanted with iodine-125.
Collapse
Affiliation(s)
- Nelson N Stone
- Department of Urology, Mount Sinai School of Medicine, New York, New York, USA.
| | | |
Collapse
|
50
|
Martin AG, Roy J, Beaulieu L, Pouliot J, Harel F, Vigneault E. Permanent prostate implant using high activity seeds and inverse planning with fast simulated annealing algorithm: A 12-year Canadian experience. Int J Radiat Oncol Biol Phys 2007; 67:334-41. [PMID: 17084553 DOI: 10.1016/j.ijrobp.2006.08.042] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Revised: 08/21/2006] [Accepted: 08/21/2006] [Indexed: 11/25/2022]
Abstract
PURPOSE To report outcomes and toxicity of the first Canadian permanent prostate implant program. METHODS AND MATERIALS 396 consecutive patients (Gleason < or =6, initial prostate specific antigen (PSA) < or =10 and stage T1-T2a disease) were implanted between June 1994 and December 2001. The median follow-up is of 60 months (maximum, 136 months). All patients were planned with fast-simulated annealing inverse planning algorithm with high activity seeds ([gt] 0.76 U). Acute and late toxicity is reported for the first 213 patients using a modified RTOG toxicity scale. The Kaplan-Meier biochemical failure-free survival (bFFS) is reported according to the ASTRO and Houston definitions. RESULTS The bFFS at 60 months was of 88.5% (90.5%) according to the ASTRO (Houston) definition and, of 91.4% (94.6%) in the low risk group (initial PSA < or =10 and Gleason < or =6 and Stage < or =T2a). Risk factors statistically associated with bFFS were: initial PSA >10, a Gleason score of 7-8, and stage T2b-T3. The mean D90 was of 151 +/- 36.1 Gy. The mean V100 was of 85.4 +/- 8.5% with a mean V150 of 60.1 +/- 12.3%. Overall, the implants were well tolerated. In the first 6 months, 31.5% of the patients were free of genitourinary symptoms (GUs), 12.7% had Grade 3 GUs; 91.6% were free of gastrointestinal symptoms (GIs). After 6 months, 54.0% were GUs free, 1.4% had Grade 3 GUs; 95.8% were GIs free. CONCLUSION The inverse planning with fast simulated annealing and high activity seeds gives a 5-year bFFS, which is comparable with the best published series with a low toxicity profile.
Collapse
Affiliation(s)
- André-Guy Martin
- Département de Radio-oncologie, Centre de Recherche en Cancérologie de l'Université Laval, Québec, Canada
| | | | | | | | | | | |
Collapse
|