The dose-volume histogram-based evaluation of predictors for gross hematuria after postprostatectomy radiotherapy

Gross hematuria following postprostatectomy radiotherapy (PPRT) is common and usually self-limited but could require hospitalization with surgical intervention in severe cases. In the present study, we have evaluated the prevalence and predictors associated with gross hematuria after PPRT.

From November 2003 to December 2017, 433 patients underwent radiotherapy after radical prostatectomy for prostate cancer. The Kaplan-Meier survival analysis was utilized to estimate the incidence of gross hematuria following PPRT, and the multivariable Cox regression analysis was performed to assess significant risk factors.

In our cohort, a total of 124 patients (28.6%) experienced gross hematuria after PPRT within a median follow-up time of 104 months. Among them, 20 patients (16.1%) required transurethral fulguration. The estimated 10-year gross hematuria-free survival rate was 67.7%. The multivariable Cox regression analysis demonstrated that treatment history of anticoagulant/antiplatelet agent [hazard ratio (HR): 1.76, P = 0.019), an absolute bladder V40 Gy ≥median (HR: 1.63, P = 0.047), and a relative bladder V65 Gy ≥median (HR: 1.82, P = 0.019) were associated with gross hematuria following PPRT.

Our results suggest that gross hematuria after PPRT occurs frequently, especially among patients on anticoagulant/antiplatelet therapy and those with an absolute bladder V40 Gy ≥median and relative bladder V65 Gy ≥median during PPRT. Although most cases of gross hematuria were self-resolved, up to 16.1% required invasive surgical intervention. Limiting PPRT dose exposure to the bladder may also reduce the incidence of gross hematuria.