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Radiation-Induced Hemorrhagic Cystitis in Prostate Cancer Survivors: The Hidden Toll
René Gatsinga1, Benjamin J H Lim1, Navin Kumar1
1Department of Urology, Singapore General Hospital, Singapore 169608, Singapore.
Medicina (Kaunas, Lithuania)
|November 27, 2024
Summary
Radiation therapy for prostate cancer can cause hemorrhagic cystitis, a complication affecting 4.5% of survivors. Antiplatelet therapy and delayed treatment increase the risk of severe outcomes and multiple procedures.
Area of Science:
- Urology
- Radiation Oncology
- Oncology
Background:
- Radiation therapy (RT) is a primary treatment for prostate cancer, improving survival rates.
- Radiation-induced hemorrhagic cystitis is a debilitating late complication of RT.
- This complication can lead to chronic morbidity and significant health issues for survivors.
Purpose of the Study:
- To determine the real-world incidence of radiation-induced hemorrhagic cystitis requiring surgical intervention.
- To identify risk factors associated with severe outcomes in patients with radiation cystitis.
Main Methods:
- Retrospective cohort study of prostate cancer survivors treated for hematuria between 2014-2024.
- Inclusion criteria: cystoscopy-confirmed radiation cystitis as the cause of hematuria.
- Statistical analyses included descriptive statistics and logistic regression (univariate and multivariate).
Main Results:
- Cumulative incidence of radiation cystitis was 4.5% at a median follow-up of 5.3 years.
- Significant predictors of multiple procedures included antiplatelet therapy (OR: 2.8) and delayed first transurethral bladder fulguration (TUBF) (OR: 1.8).
- 5.8% of patients underwent cystectomy; 53.8% required blood transfusions; 38.5% needed hyperbaric oxygen therapy.
Conclusions:
- Radiation cystitis poses a substantial long-term burden for prostate cancer survivors.
- Patients on antithrombotic agents, delayed initial presentation, and salvage RT are at higher risk for severe morbidity.
- Early identification and management of risk factors are crucial for improving outcomes in radiation cystitis patients.
