Brachytherapy for Prostate Cancer

Brachytherapy for Prostate Cancer

from Infections in Urology ®

Treatment Complications

Complications following radiation treatment are typically divided into acute (occurring during or soon after the procedure), subacute (following the acute period), and late (as a result of chronic normal tissue damage from irradiation). Acute complications following prostatic seed implant (such as perineal pain and temporary urinary retention) occur in up to 5% of patients. In the subacute period (2 to 4 months following the procedure), most patients experience some degree of obstructive or irritative uropathy with frequency, urgency, nocturia, and the feeling of incomplete voiding. Late complications can include proctitis, hemorrhagic cystitis, urinary incontinence, or impotence.

At St Elizabeth's Medical Center, we use a standard uropathy scoring system when evaluating patients at follow-up (Table I). Of our first 200 consecutive patients, 89% developed short-term grade 1 or 2 uropathy at 1 month after the procedure. This decreased to 38% by 1 year and 20% by 3 years. Only 8% of patients (16) developed grade 3 uropathy within the first month requiring prolonged medication or surgical intervention. Of these, 40% had undergone combined external beam irradiation plus implant. Six of these 16 patients required TUIP or TURP, and 6 of 16 required prolonged (more than 3 months) catheterization.

Rectal morbidity was also minimal with this procedure. At 6 months, 20 patients (10%) had developed some rectal bleeding that resolved with medical treatment. By 18 months, only 1 of these patients continued to have bleeding. Two additional patients (1%) required fulguration for more active bleeding after the procedure, but at 18 months, they were asymptomatic.

Careful placement, avoiding implanting seeds into the rectum or too close to the urethra, will minimize the risk of patients developing these symptoms. Increased uropathy with doses greater than 400 Gy to a significant portion of the urethra has been reported.[11] Overall, the incidence of side effects is considerably lower with prostate implantation than with other treatments. Table II compares complication rates from prostatic seed implants with complication rates following external beam irradiation or prostatectomy.

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