Findings at Cystoscopy Performed for Cause After Prostate Brachytherapy

Abstract

To characterize cystoscopy findings performed for cause after prostate brachytherapy in men. A retrospective review of cystoscopy reports in 2532 men treated with prostate brachytherapy with or without external beam radiation therapy for clinically localized prostate cancer between 1990 and 2011 was performed. We investigated the relationship between relevant clinical and demographic characteristics with the development of particular cystoscopic findings in patients with hematuria or lower urinary tract symptoms. One hundred eighty-five of 2532 men (7.3%) underwent cystoscopy for gross or microscopic hematuria or refractory urinary symptoms at a median time of 2.7 years after implantation and were followed up for a median of 5.9 years after treatment. Most had a negative cystoscopy finding, whereas in 67 of 185 (36.2%), the findings included bladder tumors in 18 (27%), hypervascularity in 18 (27%), radiation cystitis in 13 (19.4%), inflammation in 7 (10.4%), urethral stricture in 5 (7.5%), and calculus disease in 6 (8.9%). Cystoscopic findings did not significantly differ when stratified by cystoscopy indication (P=.515). Bladder tumors were identified in similar proportions among men with gross hematuria (9.6%) and refractory urinary symptoms (10.3%, P=.840). Cystoscopy after brachytherapy performed for cause demonstrates a relatively low incidence of benign and malignant pathologies. Detection of bladder tumors was uncommon, although equally observed among men with hematuria and urinary symptoms. Low threshold to perform cystoscopy should be considered in men with hematuria or persistent lower urinary tract symptoms after prostate brachytherapy.