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Related Experiment Videos

Prostatourethral-rectal fistula after prostate brachytherapy.

D Theodorescu1, J Y Gillenwater, P G Koutrouvelis

  • 1Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA. theodorescu@virginia.edu

Cancer
|November 7, 2000
PubMed
Summary

Prostate brachytherapy (BT) has a low risk of prostatourethral-rectal fistula (PRF), especially with monotherapy. Rectal biopsies in patients receiving combination or salvage BT increase PRF risk.

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Urology

Background:

  • Brachytherapy (BT) is increasingly used for localized or recurrent prostate cancer.
  • Iodine-125 (I-125) and Palladium-103 (Pd-103) implants are common BT modalities, often combined with external beam radiotherapy (EBRT).
  • Prostatourethral-rectal fistula (PRF) is a serious complication of BT, with limited data on its incidence and risk factors.

Purpose of the Study:

  • To determine the incidence, clinical presentation, and risk factors for PRF in patients treated with brachytherapy for prostate cancer.
  • To analyze PRF occurrence in relation to BT monotherapy, combination therapy, and salvage BT.
  • To identify specific patient management practices associated with increased PRF risk.

Main Methods:

  • A retrospective review of 765 patients treated with Pd-103 or I-125 brachytherapy between 1994 and 1999.

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  • Data collected included treatment type (monotherapy, combination, salvage), dosimetry, and clinical follow-up.
  • Analysis focused on the development of PRF, timing, and associated patient factors.

    • Main Results:

    • Seven PRFs occurred in 754 patients (1%) between 9-12 months post-treatment.
    • PRF incidence was low with monotherapy (0.2%) but higher with combination (2.9%) and salvage BT (8.8%).
    • All PRFs in combination/salvage BT occurred after rectal biopsies of anterior lesions; endoscopic evaluation alone was not a risk factor.

    Conclusions:

    • Brachytherapy monotherapy has a low incidence of PRF formation.
    • Prior rectal biopsies in patients receiving combination or salvage BT are strongly associated with PRF development.
    • Avoid rectal biopsies for radiation-induced effects to minimize PRF risk.