Login to Access Video or Poster Abstract: MP05-10
Sources of Funding: none

Introduction

Urinary symptoms in men who are treated with prostate brachytherapy (PSI) are known to worsen over time. We explored which patient and treatment related factors were associated with increased IPSS score in men who presented with minimal symptoms prior to treatment.

Methods

Of 1981 men followed a minimum 5 years (mean 10, range 5-22), 1842 (93%) had pre-implant and last IPSS. 1110 (60.3%) had minimal initial urinary symptoms (score of 0-7). There were 491 (44.2%) low risk men treated with PSI alone or with 3-6 months of neoadjuvant hormone therapy (NHT) for prostate size > 50cc, 218 (19.6%) intermediate risk men treated with PSI plus NHT, or 76 (6.8%) with external beam irradiation (45 Gy EBRT) and 325 (29.4%) high risk treated by PSI/NHT/EBRT. NHT was given a median of 9 months. Median prostate volume (PV) was 37 cc (range 2.4-188.1). Data was prospectively collected on comorbidities. Radiation dose was converted to the biological effective dose (BED). Initial IPSS was compared to last by student-t test (2 tailed). Survival estimates for minimal symptoms increasing to moderate or severe (IPSS 8-19 and 20-35) were determined by Kaplan-Meier method with comparisons by log rank and Cox Hazard Rates (HR).

Results

The change from pre-treatment score to last IPSS score for the minimal, moderate and severe symptoms was: 3.6 to 7.3 (p<0.001), 11.6 to 11.3 (p=0.426) and 24.1 to 16.9 (p<0.001). For those with minimal symptoms the 10 and 15 year estimates for freedom from worse symptoms were 72.9 and 39.1%, respectively. The 10 and 15 year estimates for pre-treatment and treatment related factors for freedom from increased IPSS are shown in the table. Cox HR for the significant variables were age (1.02, p=0.024), implant type (p=0.019), BED (1.005, p=0.005) and HTN (0.766, p=0.019). Diabetes, heart disease, race, stroke, PV, and atrial fibrillation were not significant.

Conclusions

While most symptomatic men have improved scores, a substantial number of men with low IPSS experience worsening urinary symptoms with long-term follow up after PSI. Age, implant type, radiation dose and HTN are risk factors for an increase in IPSS.

Funding

none