Ultra-long-term toxicity of prostate brachytherapy

The true long-term toxicity associated with most radiation treatments is unknown. Prostate cancer patients survive decades after prostate cancer brachytherapy, with unclear long-term toxicity profiles. We therefore evaluated prostate cancer patients who had received I-125 brachytherapy treatment (14,400 cGy) 14-24 years prior and assessed their long-term quality of life based on urinary, bowel, and sexual function.

We performed a single-institutional, retrospective analysis of 39 men who received brachytherapy between 1996 and 2005. Analysis was based on physician evaluations, laboratory values, and International Prostate Symptom Score (IPSS) results.

At last followup, the mean patient age was 80 years (median 81 years), with a mean of 17.8 years posttreatment followup. Fifteen percent of patients had experienced recurrence. Urinary symptoms were limited, with 0% of patients reporting dysuria, 13% reporting incontinence, and 33% on medication for urinary symptoms. Average times nocturia was 1.7 with mean IPSS of 6.4. With regard to bowel symptoms, 3% of patients reported incontinence, 8% noted diarrhea, 3% had rectal bleeding, 8% noted constipation, and no patients required prescription medication for bowel function. Thirty-nine percent of patients potent before treatment reported being potent with or without medication.

Prostate cancer survivors, postbrachytherapy treatment, have an overall good quality of life for many years to come. Urinary and bowel symptoms are limited, IPSS scores are generally low, and patients who consider sexual function important at their stage in life are frequently found to be potent. Overall, the long-term side effects of brachytherapy are limited at 14-24 years posttreatment.