Abstract
Dysuria following prostate radiation therapy is a common toxicity that adversely affects patients' quality of life and may be difficult to manage. Two hundred four patients treated with stereotactic body radiation therapy (SBRT) from 2007 to 2010 for localized prostate carcinoma with a minimum follow-up of 3 years were included in this retrospective review of prospectively collected data. All patients were treated to 35-36.25 Gy in five fractions delivered with robotic SBRT with real time fiducial tracking. Dysuria and other lower urinary tract symptoms were assessed via Question 4b (Pain or burning on urination) of the expanded prostate index composite-26 and the American Urological Association (AUA) Symptom Score at baseline and at routine follow-up. Two hundred four patients (82 low-, 105 intermediate-, and 17 high-risk according to the D'Amico classification) at a median age of 69 years (range 48-91) received SBRT for their localized prostate cancer with a median follow-up of 47 months. Bother associated with dysuria significantly increased from a baseline of 12% to a maximum of 43% at 1 month (p < 0.0001). There were two distinct peaks of moderate to severe dysuria bother at 1 month and at 6-12 months, with 9% of patients experiencing a late transient dysuria flare. While a low level of dysuria was seen through the first 2 years of follow-up, it returned to below baseline by 2 years (p = 0.91). The median baseline AUA score of 7.5 significantly increased to 11 at 1 month (p < 0.0001) and returned to 7 at 3 months (p = 0.54). Patients with dysuria had a statistically higher AUA score at baseline and at all follow-ups up to 30 months. Dysuria significantly correlated with dose and AUA score on multivariate analysis. Frequency and strain significantly correlated with dysuria on stepwise multivariate analysis. The rate and severity of dysuria following SBRT is comparable to patients treated with other radiation modalities.
Highlights
Over 200,000 men were diagnosed with prostate cancer in the United States in 2014, making prostate cancer the most common cancer in men [1]
The goal of this study is to report the incidence and severity of dysuria following stereotactic body radiation therapy (SBRT) for prostate cancer
Patients were treated with our institutional SBRT monotherapy protocol to 35–36.25 Gy in five fractions of 7–7.25 Gy prescribed to the planning target volume (PTV); the tumor equivalent dose in 2 Gy fractions (EQD2) is 85–90 Gy assuming an alpha/beta ratio of 1.5
Summary
Over 200,000 men were diagnosed with prostate cancer in the United States in 2014, making prostate cancer the most common cancer in men [1]. Selection of treatment modality depends on a number of factors, including age, performance status, risk stratification, and patient preference. As prostate cancer is associated with a high-cure rate and a long natural history, treatment side effects may have a large impact on quality of life (QOL). It is a commonly reported toxicity following pelvic radiation therapy and may be difficult to manage [6]. Patients with radiation-induced dysuria describe symptoms of burning or pain with urination. The risk of dysuria appears to be dependent upon a number of factors, including the prostate volume, the volume of the urethra receiving a high-radiation dose, and delayed use of alpha-blockers [7, 8]. Dysuria following prostate radiation therapy is a common toxicity that adversely affects patients’ quality of life and may be difficult to manage
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