Evaluation of chronic toxicity following radiation therapy for patients with a rising PSA status post prostatectomy

Abstract

To evaluate chronic toxicity in patients who have received external beam radiation therapy (EBRT) for a rising PSA after a radical prostatectomy (RP). A cohort of 176 consecutive patients who previously underwent a radical prostatectomy followed by a rising PSA were treated with EBRT from July 1987 through June 2003. All patients were treated with 3D conformal radiation utilizing high energy photons (10–20 MV). Patients received a median dose of 66.6 Gy (range 60–70.2 Gy in 32 to 37 fractions). Chronic toxicity and complications of EBRT were defined according to the late radiation morbidity RTOG scoring scale. With a median follow-up of 51 months (range 1–172 months), chronic complications were identified in 25 of the 176 patients (14%, 95% CI: 9% to 20%). One patient experienced a grade 4 complication (bladder/cystitis) and seven patients experienced grade 3 complications (urethral stricture). The type and grade of all complications are delineated in the table below. The one patient with a grade 4 bladder/cystitis complication was treated with a urinary diversion. The seven patients with a grade 3 urethral stricture were treated with urethral dilatation. The nine remaining patients with grade 1 and 2 complications were treated conservatively. This retrospective series with long term follow-up demonstrates that the great majority of patients receiving EBRT following RP experience minimal chronic toxicity. Only eight of the patients (5%, 95% CI: 2% to 9%) experienced a grade 3 or 4 treatment complication. Seven of the eight grade 3 complications were urethral strictures which were treated with urethral dilatations.