Author: James Benton, Andrew Dewar, Benjamin C Lee, Ryan Y Lee 👨🔬
Affiliation: Radiotherapy Clinics of Georgia, Urology of Greater Atlanta 🌍
Purpose:
The purpose of our investigation was to determine if pre-treatment factors could predict urinary morbidity after combination radiation treatment for localized prostate cancer.
Methods:
A retrospective study of a single-institution historical database was performed. Medical records of 278 consecutive patients who were treated starting May 2012 with prostate I-125 seed implant followed by intensity-modulated radiation therapy (IMRT) were analyzed. We investigated whether the following pre-existing comorbidities or factors were predictive for urinary morbidity: hypertension (HTN), diabetes (DM), smoking status, patient age, severity of pre-existing urinary symptoms, presence of prostate nodule, pre-procedure hormonal ablative therapy, confidence in erectile function, race, pre-procedure PSA, Gleason Score, use of alpha-blocker medications, and Body Mass Index (BMI). Urinary morbidity was defined as at least a 25% increase from baseline in the International Prostate Symptom Score (IPSS) at the 6-month and 12-month follow-up visit.
Results:
A total of 243 patients had complete data for inclusion at the 6-month interval and 180 patients had both 6 and 12-month data. Gleason score was 7 or higher in 173 patients. Baseline IPSS was mild (0-7) in 148 patients, moderate (8-19) in 78 patients, and severe (20-35) in 16 patients.
The results are summarized in the chart below. At 6-months, strong predictive factors were the presence of pre-existing urinary morbidity (based on IPSS) and the pre-treatment use of alpha-blocker medications. Logistic regression analysis demonstrated higher risk for younger age. At 12-months, only the IPSS was predictive.
The following combinations of factors were also evaluated: 1. HTN and DM, 2. HTN, DM, and Age, and 3. HTN, DM, Age, and BMI. Logistic regression analysis did not demonstrate an increased risk.
Conclusion:
Pre-existing urinary symptoms were strongly predictive for urinary morbidity at 6-months and 12-months post-procedure while the other multitude of factors were not. Combining pre-procedure comorbidities did not increase risk.