Identifying the predictors of acute urinary retention following magnetic-resonance-guided prostate brachytherapy

Abstract

Purpose: Larger prostate gland volumes have been associated with long-term urinary morbidity in prostate interstitial radiation therapy utilizing ultrasound image guidance technique. This study was performed to identify the clinical and technical predictors of acute urinary retention following magnetic-resonance (MR)-guided prostate interstitial brachytherapy. Methods and Materials: Fifty patients underwent MR-guided prostate brachytherapy between December 1997 and March 1999. Patient selection was limited to men with stage T1cNXM0 disease, PSA of less than10 ng/mL, biopsy Gleason score not more than 3 + 4, and endorectal coil MR stage T2 disease. Dosimetry plans were developed in the operating room and 125Iodine sources were implanted using MR real-time guidance. The peripheral zone (PZ) of the prostate gland was defined as the clinical target volume (CTV) and the minimum prescribed dose to the CTV was 137 Gy. The volumes of the PZ, transition zone (TZ), and total prostate gland volume were also determined by MR. Individual source strength ranged from 0.35 to 0.54 μGym 2/h (NIST 99, median 0.46 μGym 2/h) and the total implanted activity ranged from 17.0 to 43.1 mCi (median, 28.1 mCi) using 43–120 seeds (median, 79). The seeds were placed using MR-compatible biopsy needles (14–28, median, 19). Results: The ability of clinical (MR defined prostate, PZ, and TZ volumes) and technical (number of catheters, number of seeds implanted, and total activity) factors to predict AUR for 50 men undergoing MR-guided prostate interstitial brachytherapy were evaluated using univariable and logistic regression multivariable analyses. Six men (12%) experienced AUR within 24 h after removal of the Foley catheter subsequent to prostate brachytherapy. The total number of seeds ( p = 0.05), MR determined prostate volume ( p < 0.01), and the MR-determined TZ volume ( p < 0.01) were significant predictors of AUR on univariable analysis. Utilizing a multivariable logistic regression analysis, the TZ volume was the only significant predictor of AUR ( p < 0.01). The prostate volume is highly correlated to the TZ volume (Spearman correlation coefficient of 0.91) and was thus significant in the univariable analysis; however, the prostate volume did not add prognostic value in multivariable analysis. Conclusion: Benign prostatic hyperplasia (BPH) resulting in an enlarged TZ volume, is the most important predictor of AUR following MR-guided prostate interstitial radiation therapy. Although AUR was significant (60%) in men with moderate BPH (TZ volume ≥ 50 cc), it was also self-limiting.