Abstract
BackgroundHematuria following prostate radiotherapy is a known toxicity that may adversely affect a patient’s quality of life. Given the higher dose of radiation per fraction using stereotactic body radiation therapy (SBRT) there is concern that post-SBRT hematuria would be more common than with alternative radiation therapy approaches. Herein, we describe the incidence and severity of hematuria following stereotactic body radiation therapy (SBRT) for prostate cancer at our institution.MethodsTwo hundred and eight consecutive patients with prostate cancer treated with SBRT monotherapy with at least three years of follow-up were included in this retrospective analysis. Treatment was delivered using the CyberKnife® (Accuray) to doses of 35–36.25 Gy in 5 fractions. Toxicities were scored using the CTCAE v.4. Hematuria was counted at the highest grade it occurred in the acute and late setting for each patient. Cystoscopy findings were retrospectively reviewed. Univariate and multivariate analyses were performed. Hematuria-associated bother was assessed via the Expanded Prostate Index Composite (EPIC)-26.ResultsThe median age was 69 years with a median prostate volume of 39 cc. With a median follow-up of 48 months, 38 patients (18.3%) experienced at least one episode of hematuria. Median time to hematuria was 13.5 months. In the late period, there were three grade 3 events and five grade 2 events. There were no grade 4 or 5 events. The 3-year actuarial incidence of late hematuria ≥ grade 2 was 2.4%. On univariate analysis, prostate volume (p = 0.022) and history of prior procedure(s) for benign prostatic hypertrophy (BPH) (p = 0.002) were significantly associated with hematuria. On multivariate analysis, history of prior procedure(s) for BPH (p < 0.0001) and α1A antagonist use (p = 0.008) were significantly associated with the development of hematuria.ConclusionsSBRT for prostate cancer was well tolerated with hematuria rates comparable to other radiation modalities. Patients factors associated with BPH, such as larger prostate volume, alpha antagonist usage, and prior history of procedures for BPH are at increased risk for the development of hematuria.
Highlights
Hematuria following prostate radiotherapy is a known toxicity that may adversely affect a patient’s quality of life
Despite the high biochemical equivalent dose delivered by stereotactic body radiation therapy (SBRT) in this series, these results are similar to conventionally fractionated EBRT and brachytherapy with published studies reporting rates of hematuria that range from 2.6% - 14% [23,24,25,26,9]
Previous studies have reported that hematuria due to radiation therapy is associated with pretreatment factors related to benign prostatic hypertrophy (BPH) such as a high AUA score, large prostate volume, and pre-radiation TURP [28]
Summary
Hematuria following prostate radiotherapy is a known toxicity that may adversely affect a patient’s quality of life. We describe the incidence and severity of hematuria following stereotactic body radiation therapy (SBRT) for prostate cancer at our institution. Radiation-induced hematuria is common after prostate cancer treatment due to the close proximity of the bladder and urethra to the prostate [1]. Gurka et al Radiation Oncology (2015) 10:44 urethra/bladder neck in the high dose area [7]. Treatment related factors such as utilization of brachytherapy [8,9] or concurrent androgen deprivation therapy [10] may impact the risk of hematuria. Whether hypofrationated radiation therapy is safe in these high risk populations is yet to be explored
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.