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Title: The influence of isotope and prostate volume on urinary morbidity after prostate brachytherapy

Abstract

Purpose: To evaluate the influence of isotope and prostate size on International Prostate Symptom Score (IPSS) normalization, catheter dependency, and the need for surgical intervention secondary to bladder outlet obstruction after prostate brachytherapy. Methods and Materials: Between January 1998 and June 2003, 976 consecutive patients underwent brachytherapy for clinical stage T1b-T3a (2002 American Joint Committee on Cancer) prostate cancer. Seven hundred eighty-nine (80.8%) were implanted with {sup 103}Pd and 187 (19.2%) with {sup 125}I. The median follow-up was 41.2 months. Patients were stratified into size cohorts {<=}25 cm{sup 3}, 25.1-35 cm{sup 3}, 35.1-45 cm{sup 3}, and >45 cm{sup 3}. Four hundred eighteen patients (42.8%) received androgen deprivation therapy (ADT). Four hundred eighty-six patients (49.7%) received supplemental external-beam radiation therapy (XRT). In all patients, an alpha blocker was initiated before implantation and continued at least until the IPSS returned to baseline. IPSS resolution was defined as a return to within one point of baseline. The median number of IPSS determinations per patient was 21. Clinical, treatment, and dosimetric parameters evaluated included patient age, pretreatment PSA, Gleason score, clinical T stage, percent positive biopsies, preimplant IPSS, ultrasound volume, planning volume, isotope, V{sub 100/150/20}, D{sub 9}, urethral dose (average and maximum), supplemental XRT,more » ADT, and the duration of ADT ({<=}6 months vs. >6 months). Catheter dependency and the need for postsurgical intervention were also evaluated. Results: For both isotopes and all prostate size cohorts, IPSS peaked 1 month after implantation and returned to baseline at a mean of 1.9 months. Stratification of prostate size cohorts by isotope demonstrated no significant differences in prolonged catheter dependency ({>=}5 days), IPSS resolution, or postimplant surgical intervention. In Cox regression analysis, IPSS normalization was best predicted by preimplant IPSS, XRT, and any need for a catheter after brachytherapy. Catheter dependency correlated with prostate size and ADT, whereas the need for surgical intervention was most closely related to any catheter dependency, maximum urethral dose, ADT, and maximum IPSS increase. Conclusions: Regardless of prostate size, isotope did not impact IPSS resolution, catheter dependency, or the need for postbrachytherapy surgical intervention. Although prostate size did predict for short-term (<5 days) catheter dependency, it did not influence IPSS resolution or the need for surgical intervention.« less

Authors:
 [1];  [2];  [1];  [3];  [1];  [1];  [4];  [5]
  1. Schiffler Cancer Center and Department of Physics, Wheeling Jesuit University, Wheeling, WV (United States)
  2. Schiffler Cancer Center and Department of Physics, Wheeling Jesuit University, Wheeling, WV (United States). E-mail: gmerrick@wheelinghospital.com
  3. Puget Sound Healthcare CorporationGroup Health Cooperative and University of Washington, Seattle, WA (United States)
  4. (United States)
  5. Department of Pathology, Wheeling Hospital, Wheeling, WV (United States)
Publication Date:
OSTI Identifier:
20788277
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 64; Journal Issue: 1; Other Information: DOI: 10.1016/j.ijrobp.2005.06.035; PII: S0360-3016(05)02218-2; Copyright (c) 2006 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ANDROGENS; BIOPSY; BLADDER; BRACHYTHERAPY; CARCINOMAS; DISEASE INCIDENCE; IODINE 125; PALLADIUM 103; PATIENTS; PROSTATE; REGRESSION ANALYSIS; SURGERY; SYMPTOMS

Citation Formats

Niehaus, Angela, Merrick, Gregory S., Butler, Wayne M., Wallner, Kent E., Allen, Zachariah A., Galbreath, Robert W., Department of Physical Education and Sport Science, Ohio University, Eastern Campus, St. Clairsville, OH, and Adamovich, Edward. The influence of isotope and prostate volume on urinary morbidity after prostate brachytherapy. United States: N. p., 2006. Web. doi:10.1016/J.IJROBP.2005.0.
Niehaus, Angela, Merrick, Gregory S., Butler, Wayne M., Wallner, Kent E., Allen, Zachariah A., Galbreath, Robert W., Department of Physical Education and Sport Science, Ohio University, Eastern Campus, St. Clairsville, OH, & Adamovich, Edward. The influence of isotope and prostate volume on urinary morbidity after prostate brachytherapy. United States. doi:10.1016/J.IJROBP.2005.0.
Niehaus, Angela, Merrick, Gregory S., Butler, Wayne M., Wallner, Kent E., Allen, Zachariah A., Galbreath, Robert W., Department of Physical Education and Sport Science, Ohio University, Eastern Campus, St. Clairsville, OH, and Adamovich, Edward. Sun . "The influence of isotope and prostate volume on urinary morbidity after prostate brachytherapy". United States. doi:10.1016/J.IJROBP.2005.0.
@article{osti_20788277,
title = {The influence of isotope and prostate volume on urinary morbidity after prostate brachytherapy},
author = {Niehaus, Angela and Merrick, Gregory S. and Butler, Wayne M. and Wallner, Kent E. and Allen, Zachariah A. and Galbreath, Robert W. and Department of Physical Education and Sport Science, Ohio University, Eastern Campus, St. Clairsville, OH and Adamovich, Edward},
abstractNote = {Purpose: To evaluate the influence of isotope and prostate size on International Prostate Symptom Score (IPSS) normalization, catheter dependency, and the need for surgical intervention secondary to bladder outlet obstruction after prostate brachytherapy. Methods and Materials: Between January 1998 and June 2003, 976 consecutive patients underwent brachytherapy for clinical stage T1b-T3a (2002 American Joint Committee on Cancer) prostate cancer. Seven hundred eighty-nine (80.8%) were implanted with {sup 103}Pd and 187 (19.2%) with {sup 125}I. The median follow-up was 41.2 months. Patients were stratified into size cohorts {<=}25 cm{sup 3}, 25.1-35 cm{sup 3}, 35.1-45 cm{sup 3}, and >45 cm{sup 3}. Four hundred eighteen patients (42.8%) received androgen deprivation therapy (ADT). Four hundred eighty-six patients (49.7%) received supplemental external-beam radiation therapy (XRT). In all patients, an alpha blocker was initiated before implantation and continued at least until the IPSS returned to baseline. IPSS resolution was defined as a return to within one point of baseline. The median number of IPSS determinations per patient was 21. Clinical, treatment, and dosimetric parameters evaluated included patient age, pretreatment PSA, Gleason score, clinical T stage, percent positive biopsies, preimplant IPSS, ultrasound volume, planning volume, isotope, V{sub 100/150/20}, D{sub 9}, urethral dose (average and maximum), supplemental XRT, ADT, and the duration of ADT ({<=}6 months vs. >6 months). Catheter dependency and the need for postsurgical intervention were also evaluated. Results: For both isotopes and all prostate size cohorts, IPSS peaked 1 month after implantation and returned to baseline at a mean of 1.9 months. Stratification of prostate size cohorts by isotope demonstrated no significant differences in prolonged catheter dependency ({>=}5 days), IPSS resolution, or postimplant surgical intervention. In Cox regression analysis, IPSS normalization was best predicted by preimplant IPSS, XRT, and any need for a catheter after brachytherapy. Catheter dependency correlated with prostate size and ADT, whereas the need for surgical intervention was most closely related to any catheter dependency, maximum urethral dose, ADT, and maximum IPSS increase. Conclusions: Regardless of prostate size, isotope did not impact IPSS resolution, catheter dependency, or the need for postbrachytherapy surgical intervention. Although prostate size did predict for short-term (<5 days) catheter dependency, it did not influence IPSS resolution or the need for surgical intervention.},
doi = {10.1016/J.IJROBP.2005.0},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 1,
volume = 64,
place = {United States},
year = {Sun Jan 01 00:00:00 EST 2006},
month = {Sun Jan 01 00:00:00 EST 2006}
}