Factors influencing long-term urinary symptoms after prostate brachytherapy

Area of Science:

• Urology
• Oncology
• Radiation Oncology

Background:

• Prostate cancer treatment, particularly brachytherapy (BT), is common for men with localized disease.
• Assessing long-term urinary symptom progression after BT is crucial for patient management.
• Understanding factors influencing symptom changes can optimize treatment strategies.

Purpose of the Study:

• To identify patient and treatment-related factors associated with increased American Urological Association symptom score (AUASS) in men initially presenting with minimal urinary symptoms.
• To evaluate the long-term impact of brachytherapy alone versus brachytherapy with neoadjuvant hormone therapy and/or external beam radiation therapy on urinary symptoms.

Main Methods:

• Analysis of data from 1842 men treated with brachytherapy for prostate cancer, with a minimum 5-year follow-up.
• Comparison of initial AUASS with long-term scores using statistical tests, including Student's t-test and Kaplan-Meier analysis.
• Cox proportional hazards models were used to determine risk factors for worsening symptoms.

Main Results:

• A significant increase in AUASS was observed in men initially treated for minimal symptoms (3.6 to 7.3, P < 0.001).
• The 10- and 15-year estimates for freedom from worsening symptoms were 72.9% and 39.1%, respectively.
• Significant risk factors for increased AUASS included external beam radiation therapy (EBRT) boost (HR 1.45), RT dose >200 Gy2 (HR 1.25), hypertension (HR 1.37), and alcohol use (HR 1.46).

Conclusions:

• A considerable proportion of men treated with brachytherapy for prostate cancer experience a long-term increase in urinary symptoms.
• External beam radiation therapy, higher radiation doses, hypertension, and alcohol consumption are identified as significant risk factors for worsening urinary symptoms.