Treatment-related symptoms during the first year following transperineal 125I prostate implantation

Abstract

Purpose : To summarize the urinary, rectal, and sexual symptoms occuring during the first 12 months following 125I prostatic implantation. Methods and Materials : Thirty-one patients with Stage T 1 or T 2 prostatic carcinoma were evaluated for morbidity following computed tomography-guided transperineal 1251 implants from 1988 to 1991. The median total activity used was 47 mCi (range 35–73 mCi). Toxicity was evaluated using a modification of the Radiation Therapy Oncology Group grading system. Results : Nocturia was the most common treatment-related symptom, reported by 80% of patients within 2 months after implantation, and persisted at 12 months in 45% of the patients. Mild dysuria developed in 48% of patients within 2 months of implantation; two patients needed analgesics for their dysuria. Terazosin hydrochloride (2–10 mg qd) provided subjective improvement of urinary symptoms in seven of eight patients in whom it was tried. Rectal urgency, soft stools, and increased frequency of bowel movements was reported by 25% of the patients within 1–2 months after implantation. The incidence of assymptomatic rectal bleeding or ulceration occurring at any time after implantation was 47%, but resolved in all patients with expectant treatment. Self-limited ulceration of the rectal mucosal occurred in 16%, but only one patient developed a prostato-rectal fistula, managed with an ileal conduit. Five of the 18 potent patients experienced discomfort on erection or ejaculation, beginning within several weeks of their implant. The discomfort resolved within 6 months in three of the patients, but persisted for 18 and 24 months in the other two. Conclusion : 125I implantation, as performed in this series, is generally associated with only mild-moderate genitourinary and rectal symptoms that may persist 6 months or more after implantation. Prostatic carcinoma, Brachytherapy, Morbidity.