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Factors predicting for urinary incontinence after prostate brachytherapy
Tracy L McElveen1, Frank M Waterman, Hayeon Kim
1Department of Radiation Oncology, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University, 111 South 11th Street, Philadelphia, PA 19107-5097, USA.
Summary
Urinary incontinence after iodine-125 (125I) prostate brachytherapy is predicted by urethral D(10) dose and preimplant International Prostate Symptom Score (I-PSS). Keeping urethral D(10) dose low and selecting patients with I-PSS scores under 15 can reduce this risk.
Area of Science:
- Urology
- Radiation Oncology
- Medical Physics
Background:
- Prostate brachytherapy using iodine-125 (125I) is a common treatment for localized prostate cancer.
- Urinary incontinence is a potential complication following this procedure.
- Identifying predictive risk factors is crucial for patient counseling and treatment planning.
Purpose of the Study:
- To identify risk factors predicting urinary incontinence after 125I prostate brachytherapy.
- To evaluate the role of dosimetric and clinical parameters in the development of post-brachytherapy incontinence.
Main Methods:
- A cohort of 153 patients undergoing 125I prostate brachytherapy was retrospectively analyzed.
- Urinary incontinence was assessed using a patient self-assessment questionnaire based on NCI Common Toxicity Criteria.
- Multivariate analysis was performed on clinical (age, Gleason score, PSA, I-PSS) and dosimetric (urethral D(10), prostate V100, etc.) parameters.
Main Results:
- Urethral D(10) dose and preimplant International Prostate Symptom Score (I-PSS) were significant predictors of urinary incontinence (p=0.002 and p=0.003).
- Incontinence incidence increased significantly when urethral D(10) exceeded 450 Gy and preimplant I-PSS was greater than 15.
- No significant relationship was found between incontinence and prostate volume, total activity, or number of needles.
Conclusions:
- Urethral D(10) dose and preimplant I-PSS are key predictors of urinary incontinence risk after 125I prostate brachytherapy.
- Optimizing treatment planning to minimize urethral D(10) and careful patient selection based on I-PSS can help reduce the incidence of this complication.