Urinary morbidity after permanent prostate brachytherapy – Impact of dose to the urethra vs. sources placed in close vicinity to the urethra

Pinkawa, Michael; Holy, Richard; Piroth, Marc D.; Klotz, Jens; Pfister, David; Heidenreich, Axel; Eble, Michael J.

doi:10.1016/j.radonc.2011.12.011

« Previous Next »Radiotherapy & Oncology
Volume 103, Issue 2 , Pages 247-251, May 2012

Urinary morbidity after permanent prostate brachytherapy – Impact of dose to the urethra vs. sources placed in close vicinity to the urethra

Michael Pinkawa
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany
- Corresponding author. Address: Department of Radiation Oncology, RWTH Aachen University, Pauwelsstrasse 30, 52057 Aachen, Germany.
Richard Holy
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany
Marc D. Piroth
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany
Jens Klotz
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany
David Pfister
- Department of Urology, RWTH Aachen University, Aachen, Germany
Axel Heidenreich
- Department of Urology, RWTH Aachen University, Aachen, Germany
Michael J. Eble
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany

Received 22 October 2010; received in revised form 17 November 2011; accepted 28 December 2011. published online 02 February 2012.

Abstract

Background and purpose

The impact of the dose to the urethra and sources placed close to the urethra on urinary morbidity after permanent prostate brachytherapy (PPB) is not well known.

Materials and methods

Fifty-nine patients were surveyed prospectively before treatment (A), 1month after (B) and >1year after PPB (C) using a validated questionnaire (Expanded Prostate Cancer Index Composite). Computed tomography (CT) postimplant scans were performed at days 1 (Foley catheter in situ) and 30 after PPB and sources within 5mm of the urethra at day 1 were identified.

Results

As opposed to the urethral dose–volume histogram, a larger number of sources within 5mm of the urethra at day 1 predicted significantly larger urinary bother score changes at times B and C – with an impact on incontinence and frequency (e.g. moderate/big problem with leaking urine in 25% vs. 3%, p=0.02; moderate/big problem with frequent urination in 33% vs. 7%, p<0.01, at time C with vs. without ⩾3 sources in a single strand placed close to the urethra).

Conclusions

Placement of sources with a minimum distance of a few mm to the urethra should be a major aim to avoid urinary morbidity irrespective of the urethral dose–volume histogram.

Keywords: Prostate cancer, Quality of life, Brachytherapy, I-125, Postimplant dosimetry