AUA Scores Research Articles

Comparison of Ventral Inlay and Dorsal Onlay Urethroplasty for Female Urethral Stricture

ObjectiveTo compare the outcomes of Ventral inlay buccal mucosal graft urethroplasty (VIBMGU) with dorsal onlay buccal mucosal graft urethroplasty (DOBMGU) for the treatment of Female urethral stricture (FUS). Material and MethodsThis study included women who underwent either VIBMGU or DOBMGU between January 2016 and June 2023. The preoperative AUA symptom scores, maximal urinary flow rate (Qmax), post-void residual volume (PVR) on ultrasonography, and length and location of the stricture were obtained from a prospectively maintained electronic database. The data obtained from the patient’s last visit was compared with the preoperative values for this study. The primary outcome was the success rate. The secondary outcomes were changes in AUA score, PVR, and Qmax. The patient's last follow-up visit was considered for the duration of the follow-up. ResultsSeventy-three patients were treated for BMGU for FUS. Forty-six patients underwent VIBMGU, and 27 patients underwent DOBMGU. The median duration of follow-up was 27.5 11.00-55.00) versus 14 (7.00-17.00) months respectively. The success rates of VIBMGU and DOBMGU were 89.13% and 88.89% respectively. There was a reduction in AUA scores and PVR and an improvement in Qmax postoperatively in both groups. The difference in the reduction in AUA scores between the VIBMGU and DOBMGU groups was statistically significant. The difference was not statistically significant in terms of reduction in PVR and improvement in Qmax between the two groups. ConclusionThe ventral inlay technique can provide equal results to the dorsal technique with the added advantage of vaginal sparing. This is the single largest series in the literature on female urethral stricture with the largest follow-up period of 90 months.

MP61-10 URINARY FUNCTIONAL OUTCOMES OF RADICAL PROSTATECTOMY VS. RADIATION THERAPY FOR PROSTATE CANCER FOLLOWING HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP)

You have accessJournal of UrologyCME1 Apr 2023MP61-10 URINARY FUNCTIONAL OUTCOMES OF RADICAL PROSTATECTOMY VS. RADIATION THERAPY FOR PROSTATE CANCER FOLLOWING HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) Alex Piroozi, Austen Slade, RJ Caras, T. Max Shelton, Udit Vyas, Katrina Collins, Omar Ishaq, Mohamed Elsaqa, Corey Able, Ronald Boris, Marawan M. El tayeb, Marcelino Rivera, and James Lingeman Alex PirooziAlex Piroozi More articles by this author , Austen SladeAusten Slade More articles by this author , RJ CarasRJ Caras More articles by this author , T. Max SheltonT. Max Shelton More articles by this author , Udit VyasUdit Vyas More articles by this author , Katrina CollinsKatrina Collins More articles by this author , Omar IshaqOmar Ishaq More articles by this author , Mohamed ElsaqaMohamed Elsaqa More articles by this author , Corey AbleCorey Able More articles by this author , Ronald BorisRonald Boris More articles by this author , Marawan M. El tayebMarawan M. El tayeb More articles by this author , Marcelino RiveraMarcelino Rivera More articles by this author , and James LingemanJames Lingeman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003319.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer is a well-documented finding in Holmium Laser Enucleation of the Prostate (HoLEP); however, there is little data on the outcomes of patients who underwent HoLEP followed by definitive therapy for subsequent prostate cancer diagnosis. We sought to compare the urinary functional outcomes after undergoing radical prostatectomy or external beam radiation for prostate cancer following HoLEP. METHODS: All patients from 2010 to 2021 at Indiana University and Baylor Scott and White Hospitals who underwent radiation or prostatectomy for treatment of prostate cancer after HoLEP were included. We performed a retrospective analysis of their urinary function with greater than 1-year post-treatment American Urological Association Symptom Index (AUA), Quality of Life (QOL), and incontinence follow up. Incontinence was defined as patient reported leakage of any urine. RESULTS: There were 33 radical prostatectomy and 36 radiation patients who met the inclusion criteria. There was no statistical significance between the mean AUA scores of greater than 1-year post-prostatectomy patients (7.69) and post-radiation patients (8.08) (p=0.8175). Similarly, there was no statistical significance between the QOL scores of greater than 1-year post-prostatectomy patients (1.96) and post-radiation patients (2.00) (p=0.9175). There is a statistically significant decrease in complaints of incontinence in greater than 1-year post-radiation patients (28%) compared to post-prostatectomy patients (73.3%) (p=0.0017). There was also a significant difference between mean age of the prostatectomy group (66.4 years) and the radiation group (75.3 years) (p<0.001). There was no significant difference in BMI, pre-HoLEP prostate size, pre-HoLEP AUA score, or pre-HoLEP QOL score between the groups. CONCLUSIONS: Radical prostatectomy and radiation provide similar AUA and QOL symptom scores for prostate cancer patients who previously underwent HoLEP, with radiation associated with decreased incidence of incontinence. Patients specifically concerned with the risk of incontinence following prostate cancer treatment may consider the increased risk from a prostatectomy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e856 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Piroozi More articles by this author Austen Slade More articles by this author RJ Caras More articles by this author T. Max Shelton More articles by this author Udit Vyas More articles by this author Katrina Collins More articles by this author Omar Ishaq More articles by this author Mohamed Elsaqa More articles by this author Corey Able More articles by this author Ronald Boris More articles by this author Marawan M. El tayeb More articles by this author Marcelino Rivera More articles by this author James Lingeman More articles by this author Expand All Advertisement PDF downloadLoading ...

Toxicity Outcomes at 18 Months for Cs-131 Low-Dose-Rate Prostate Brachytherapy Compared to I-125 and Pd-103

<h3>Purpose/Objective(s)</h3> Low dose rate prostate brachytherapy is an established component of definitive radiotherapy options for localized prostate cancer. As the utility of LDR brachytherapy (LDRB) has evolved, the focus has shifted to improving the side effect profile while maintaining oncologic outcomes. Most prior efficacy and toxicity data were gathered using I-125 and Pd-103, but due to the shorter half-life and slightly higher average energy of Cs-131, several institutions have adopted its use in an attempt to improve outcomes and decrease toxicity. To report the toxicity outcomes up to 18 months after Cs-131 LDR brachytherapy at our institution, compared to our experience with I-125 and Pd-103. <h3>Materials/Methods</h3> A retrospective review was performed on the first 50 patients treated with Cs-131 LDRB for localized prostate cancer at our institution. Patients receiving either a full or partial implant were included. Prescription doses of 100Gy and 80Gy were utilized, respectively. Patients receiving partial implants generally received 45Gy external beam radiotherapy starting 6-8 weeks after implant. Data regarding AUA prostate symptom score, sexual health inventory for men (SHIM) score, and RTOG GI toxicity score were assessed pretreatment, at 1 month, and at each subsequent follow up. Demographic and clinical data were also collected. The data was compared to cohorts of the last 50 patients treated I-125 and the last 50 patients treated with Pd-103, to standard doses. Descriptive statistics were used to summarize variables. A linear mixed model was used to compare means and to identify variables as prognostic for toxicity (p≤0.05). <h3>Results</h3> The mean AUA scores prior to brachytherapy were similar for patients in all groups (p=1.00), while at 1-month post-treatment, mean AUA score was significantly higher for patients treated with Cs-131 and Pd-103 compared to I-125 (p<0.001). Mean AUA scores were not significantly different at longer follow-up (p>0.50). The need for a catheter post-brachytherapy occurred in 8% of patients and was not associated with type of isotope on multivariate analysis (MVA). Prostate volume, numbers of seeds, and prostate D90% were significant predictors for the need for a catheter on MVA. The use of ADT and the total activity were significant predictors on MVA for a decrease in SHIM score over time. The type of isotope used did not predict for erectile dysfunction (ED) as measured by SHIM score on MVA. Overall rates of GI toxicity were low with only 3 patients developing RTOG grade 2 toxicity or greater without any obvious difference between isotopes. <h3>Conclusion</h3> In patients treated with Cs-131 or Pd-103 LDRB, acute GU side effects peaked higher at 1 month than with I-125, but rapidly decreased to similar levels with longer follow-up. The type of source used did not predict for need for catheterization, ED, or GI toxicity at any time point.

Effect of short-term corticosteroid usage on acute urinary toxicity following Cs-131 prostate brachytherapy

To evaluate short-term patient reported urinary quality of life scores in patients with prostate cancer treated at our institution with and without perioperative prednisone following Cesium-131 (131Cs) prostate LDR brachytherapy. We started routinely using a perioperative 7-day course of prednisone at a dose of 5 mg per day, beginning 1 day prior to 131Cs prostate LDR brachytherapy from 2013 with goal of improving acute urinary symptomatology. One hundred consecutive patients treated with prednisone were selected, with comparison to 100 consecutive patients who were not treated with prednisone. We analyzed for differences in mean change with standard deviation (SD) in EPIC and AUA scores at 0.5-1 month and 3 months with or without prednisone by Mann-Whitney U Test. Binary logistic regression was performed to assess for impact of prednisone on postoperative urinary catheter use. Pretreatment EPIC and AUA scores were available in 197 patients. Less reduction in EPIC US score was noted at 0.5-1.0 month in the group who received prednisone with mean change of -22.9 (SD 15.4) when compared to the group who did not receive prednisone with mean change of -31.7 (SD 19.3), p < 0.01, with significance lost at 3 months. There was no significant difference in acute urinary retention requiring postoperative urinary catheter placement with perioperative prednisone (OR 1.13, p = 0.71). A short course of perioperative low-dose prednisone was associated with less severe worsening in urinary symptoms by the EPIC questionnaire at the 0.5-1.0-month timepoint suggesting some improvement in acute urinary quality of life, although differences did not remain statistically significant at 3 months.

A phase II trial of hypofractionated radiation therapy over five treatments for prostate cancer with high-risk features after radical prostatectomy: MC1754.

248 Background: Hypofractionated prostate cancer radiation has showed similar results in several prior phase III studies (PCG GU 003, PACE-B, and Hypo PC RT). However, prospective phase II-III clinical trial data testing 5 tx after prostatectomy is scarce. Methods: Between 2018 and 2019, 41 patients were treated after postprostatectomy for high risk features. 5 patients were treated adjuvantly, 36 for salvage including 8 with oligometastatic disease. Indications for adjuvant RT included a PSA &lt; 0.2 and +margins, SVI, or EPE. Salvage RT was offered for PSA ≥0.2. Oligometastatic RT for patients with ≤5 RT targets. Staging included C11 PET for all cases. Total dose to the prostate bed was 30-32 Gy in 5tx QOD with IMRT, conebeam IGRT, and MRI registration. All salvage patients received ADT for 6 months and oligometastatic patients for 18 months. Dose to the metastatic sites was 30 in 5tx QOD. Of the 41 patients 8 also received SBRT to the sites of oligometastatic disease. We looked at clinical outcomes defining biochemical failure as a PSA &gt; 0.2 after treatment, baseline adjusted CTC AE V5.0, baseline adjusted patient reported toxicities (PRO CTC AE), QOL (EPIC, PROMIS), and AUA was used for all cases. Results: Median follow up was 23 months (range 10-37). Pre-RT T stage was T2-T3b, with 47% being T3a-b; Pre RT Median PSA of 0.4 (range &lt; 0.1-1.9); Median GS 8 (6-9); and (+) margins in 48.8%. Sites of oligometastatic disease radiated included the LN and bone. Treatment related AE were grade 0-1 in all cases, except for one patient with G2 GU incontinence. Overall QOL remained high during follow including Promis 10 overall, mental, and physical scores; urinary bother, irritative/obstructive, and AUA scores; bowel overall, bowel bother, and bowel function scores; and overall sexual, sexual function, and sexual bother scores remained at baseline levels during follow up. Only hormonal overall, hormonal function, and hormonal bother had lower scores at 3 months that recovered by 12 months in patients treated with ADT for 6 months and by 24 months in patients treated with ADT for 18 months. A total of 3 clinical failure have been seen; 2 patients with regional failures alone; and one with axial skeleton bony failures for 93% clinical control at median follow up of 23 months. All 3 patients with clinical failure were salvaged successfully with SBRT and all patients remain disease free at last follow up. A total 5 patients with raising PSAs alone have been seen. All patients have been re-staged with C11 PET. No failures in the prostate bed or previously radiated sites have been seen. Conclusions: Toxicity for RT over 5tx is lower than expected with only one case of grade 2 urinary incontinence. QOL scores remained high during follow up, minor changes in hormonal scores were seen during ADT, but recovered after. 30-32 Gy over 5 tx provided 100% control in radiated targets and metastatic sites. Clinical trial information: NCT03570827.

Patient Reported Outcomes (PRO) in Those Receiving a High Dose Rate (HDR) Brachytherapy Prostate Boost Compared to Intensity Modulated Radiotherapy (IMRT) Alone

Prospective data show improved biochemical control-at a cost of worse urinary and overall physical function scores-in patients receiving a low dose rate (LDR) prostate brachytherapy boost when compared to IMRT alone. An HDR prostate boost may cause less toxicity than LDR brachytherapy. We, therefore, compared patient status post an HDR prostate boost or IMRT alone to see if there were any differences in PRO data between groups.American Urologic Association (AUA) symptom score and Sexual Health Inventory for Men (SHIM) score were prospectively collected for men with intermediate/high risk prostate cancer at a single institution. Genitourinary (GU) and gastrointestinal (GI) toxicity were also obtained and graded using the Common Terminology Criteria for Adverse Events v3.0 (CTCAE). Patients had undergone either IMRT plus an HDR prostate boost (n = 53) or IMRT alone (n = 346). Patients were excluded if they had prior TURP, a history of irritable bowel disease (IBD), or a prostate size greater than 75 cc. PRO were compared at baseline and at 1-2 years. AUA and SHIM scores were compared using a two-sample Wilcoxon rank-sum test.We identified 346 patients treated between 2001 and 2018 with IMRT alone (80 Gy median EBRT dose) and 53 patients treated with HDR boost (46 Gy median EBRT dose). Patient characteristics and unadjusted PRO scores are reported below in the table. There was no grade 4 or 5 acute or late GU or GI events.Zero grade 3 late GI events occurred in the IMRT plus HDR group, while 1.7% of patients (n = 6) in the IMRT alone group experienced late grade 3 GI toxicity; this difference was not statistically significant. Patients receiving an HDR boost have greater change in AUA score at 1-2 years compared to the IMRT alone patients; this change does not appear clinically significant. SHIM scores are higher in the HDR group before and after treatment, suggesting patients selected for a prostate boost may have better erectile function at baseline. Lastly, clinicians seem more comfortable withholding ADT in patients receiving an HDR prostate boost, possibly due to the higher ablative dose provided by HDR brachytherapy.

Patient Reported Quality of Life Outcomes After Definitive Radiation Therapy With Absorbable Spacer Hydrogel for Prostate Cancer

PurposeSpaceOAR is a device approved for conventional radiation in prostate cancer. We sought to observe prospectively how SpaceOAR Hydrogel effected quality of life and dosimetry to organs at risk at our institution. Methods and MaterialsWe prospectively enrolled patients with low risk or favorable-intermediate risk localized prostate cancer. Baseline Expanded Prostate Cancer Index Composite (EPIC-26) scores along with baseline American Urology Association Symptom Index (AUA-SI) scores were collected. SpaceOAR was placed for all patients who then received stereotactic body radiation therapy, low dose rate brachytherapy, conventionally fractionated radiation therapy, or moderately hypofractionated radiation therapy. We evaluated postimplant dosimetry to critical structures, and prospectively collected follow-up EPIC-26 and AUA-SI scores. We performed a repeated measures analysis of variance to compare patient-specific responses and correlated survey data with dosimetric metrics by generating linear regression models. ResultsWe enrolled 59 patients in this study with a median follow-up of 366 days (interquartile range, 507). At final follow-up, the "?>prostate-specific antigen had a significant decline compared with baseline (P < .0001). There were no grade 3 toxicities on treatment. There were no significant changes in the AUA-SI score (P = .69) at final follow-up compared with baseline, nor was there any change in EPIC-26 domain scores (P = .19) during the course of the study period. There were no significant associations between AUA scores and EPIC-26 scores and the dose to the rectum, bladder, or urethra with the exception being dose to the 2 mL rectum correlated with decline in EPIC-26 rectal score (β, −0.002; P = .006). Patient-reported declines in bowel domains were less than previously reported data. ConclusionsUse of SpaceOAR results in favorable dosimetry to the organs at risk and portends excellent short-term quality of life as measured by the association with the patient reported outcome measures. Longer-term follow-up is ongoing and necessary to assess the long-term effect and association of the hydrogel.

Biochemical Control and Toxicity Outcomes of SBRT vs LDR Brachytherapy in the Treatment of Low and Intermediate Risk Prostate Cancer

Abstract Purpose /Objective(s): Low dose rate (LDR) brachytherapy and Stereotactic Body Radiation Therapy (SBRT) have both shown acceptable outcomes in the treatment of low and intermediate risk prostate cancer. Minimal data has been published directly comparing rates of biochemical control and toxicity with these two modalities. We hypothesize that LDR and SBRT will provide similar rates of biochemical control. Materials/Methods All low and intermediate risk prostate cancer patients treated definitively with SBRT or LDR between 2010 and 2018 were captured. Phoenix definition was used for biochemical failure. Independent t-tests were used to compare baseline characteristics, while repeated measure ANOVA was used to compare AUA and EPIC scores between treatment arms over time. Biochemical control was estimated using the Kaplan Meier method. Differences in acute and late toxicity were assessed via Pearson chi-square. Results 219 and 118 patients were treated with LDR and SBRT. Median follow-up was 4.3 years (interquartile range:3.1-6.1). All patients treated with LDR received 125.0 Gy in a single fraction. SBRT consisted of 42.5 Gy in 5 fractions. 5-year biochemical control for LDR versus SBRT was 91.6% vs. 97.6% (p=.108). LDR patients had a larger increase in mean AUA scores at one month (17.2 vs. 10.3, p Conclusion Our data shows similar biochemical control and GU toxicity rates at 5 years for both SBRT and LDR, with slightly higher GI toxicity with SBRT and higher AUA and EPIC scores with LDR.

Modified simple prostatectomy: an approach to address large volume BPH and associated prostate cancers.

Simple prostatectomy is an option for management of patients with enlarged prostates and obstructive symptoms. However, the guidelines still do not state a gold-standard treatment for men with BPH and some of these patients with BPH are also known to harbor prostate cancer. This issue can be a challenge because, in the traditional simple prostatectomy, the prostate capsule is often left in place, and that is usually the area of the prostate cancers. With the robotic approach, our goal is to analyze the outcomes of modified simple prostatectomy (MSP) by the elimination of the entire prostate tissue. Thirty-four patients underwent MSP for BPH diagnosis. We evaluated the pre- and postoperative clinical characteristics as well as pathological data. MSP was performed using the DaVinci Xi robot; the entire prostate was removed. We performed a full nerve sparing bilaterally with an intrafascial plane dissection, minimal apical dissection, seminal vesicles sparing, and full vesicourethral anastomosis. The pre- and postoperative AUA scores were compared on paired T test. The mean operative time and blood loss were 126min and 160.5ml, respectively. The final pathology report described 17 patients (50%) with BPH and 17 (50%) with BPH and prostate adenocarcinoma. After surgery, 97% had an AUA score improvement. Regarding the patients with a prostate cancer diagnosis, 97% had PSA lower than 0.01ng/ml. Modified simple prostatectomy is an acceptable treatment option for men with BPH. The procedure allows for significant symptom relief and removal of chronic catheters. Our modified approach was able to eliminate the entire prostate, which was significant because 50% of these patients had prostate cancer on the final pathology.

Hypofractionated external beam radiation therapy in combination with HDR boost for localized prostate cancer: patient reported quality of life outcomes.

PurposeThere is limited data to support the use of hypofractionated external beam radiation (HypoF) in combination with high-dose-rate brachytherapy (HDR). We report our quality of life (QOL) outcomes when treating intermediate and high-risk prostate cancer patients with external beam radiation (EBRT) plus HDR.Material and methodsThe charts of 54 patients with localized adenocarcinoma of the prostate treated with standard fractionation (SF) or HypoF EBRT plus HDR boost at a single institution between 2012 and 2015 were reviewed. All patients completed the American Urological Association Symptom Score (AUASS) and Expanded Prostate Index for Prostate Cancer – Clinical Practice (EPIC-CP) quality of life assessments prior to treatment and completed at least one follow-up survey. Linear mixed models were performed to test for significant changes and differences in each outcome over time.ResultsThere was no significant difference in AUA score (p = 0.98), incontinence (urge) and urinary irritation/obstruction scores (p = 0.81 and p = 0.62, respectively), and bowel QOL (p = 0.97) between the two dosing groups over time or at any discrete time point. For both groups, AUA scores peaked at 0-2 months before improving. Likewise, sexual function, vitality score, and QOL scores were also not significantly different between the dose groups over time (p = 0.59, p = 0.37, and p = 0.71, respectively). All QOL categories, except sexual function, trended toward baseline with increasing time from intervention.ConclusionsOur study suggests HypoF EBRT can be delivered in combination with HDR for patients with ntermediate-risk and high-risk adenocarcinoma of the prostate without increasing toxicity compared to SF with an HDR boost.

Brachytherapy for localized prostate cancer in the modern era: a comparison of patient-reported quality of life outcomes among different techniques.

PurposeTo report our institutional quality of life (QOL) data for low-dose-rate (LDR) monotherapy (LDR mono), high-dose-rate (HDR) monotherapy (HDR mono), and EBRT with an HDR brachytherapy boost (HDR boost).Material and methodsThe charts of 165 patients with localized adenocarcinoma of the prostate treated with LDR monotherapy (LDR mono), HDR monotherapy (HDR mono), and EBRT with an HDR brachytherapy boost (HDR boost) at a single institution between 2012 and 2015 were reviewed. All patients completed the American Urological Association symptom score (AUASS) and Expanded Prostate Index for Prostate Cancer – Clinical Practice (EPIC-CP) quality of life assessments prior to treatment and at least one follow-up survey. Time points included baseline, ≤ 2 months, 2-≤ 6 months, 6-≤ 12 months, 12-≤ 18 months, 18-≤ 24 months, 24-≤ 30 months, and > 30 months. Linear mixed models were performed to test for significant changes and differences in each outcome over time.ResultsMean follow-up was 19.5 months. All major functional QOL domains were affected after treatment with brachytherapy for localized prostate cancer. All domains improved over time, with the exception of sexual function scores for all groups and urinary incontinence scores for the HDR mono group. Patients treated with LDR did have higher AUA, irritability/obstructive symptoms, incontinence, bowel, and QOL scores acutely compared to the HDR and HDR + boost groups. Vitality scores were significantly worse in the HDR boost group both acutely and at the > 30-month time point.ConclusionsPatients receiving HDR brachytherapy had lower acute urinary and rectal toxicity compared to the patients receiving LDR, even when combined with EBRT. However, long-term toxicity was similar.

Long-Term Quality of Life in Prostate Cancer Patients Treated With Cesium-131

Toevaluate long-term patient-reported quality of life (QOL) scores in men with prostate cancer treated at our institution with 131Cs prostate brachytherapy. Patients treated more than 4years ago with 131Cs (n=290) were asked to fill out an Expanded Prostate Cancer Index Composite (EPIC) QOL questionnaire and American Urological Association Symptom Score (AUASS) survey, before treatment and at each follow-up appointment. We compared patients' EPIC and AUA scores at baseline with scores at a last follow-up of at least 4years after treatment using the Wilcoxon signed-rank test. At a median last follow-up of 5.5years after treatment with 131Cs prostate brachytherapy there were no clinically significant changes in the EPIC or AUA scores from baseline. There was statistical worsening in the EPIC urinary incontinence subscore. Subset analyses revealed improved QOL outcomes in patients who received external beam radiation therapy or α-blocker therapy, whereas androgen deprivation therapy was not associated with differences in QOL change. Our results demonstrate minimal long-term changes in urinary or bowel patient-reported QOL with 131Cs prostate brachytherapy. These findings suggest that patients treated with this isotope are able to recover and then maintain their baseline QOL in the long term.

The impact of pretreatment MRI on genitourinary and gastrointestinal toxicity after radiation therapy in patients with localized prostate cancer.

119 Background: MRI has several advantages relative to other imaging modalities in evaluating, diagnosing, and planning treatment for prostate cancer yet it is rarely ordered for localized disease. While the diagnostic abilities have been studied, little has been done to associate clinical outcomes with prostate cancer patients who received MRI. We evaluated the effect of pre-treatment MRI on genitourinary (GU) and gastrointestinal (GI) toxicity in prostate cancer patients who received definitive radiation treatment. Methods: We retrospectively analyzed prostate cancer patients who underwent definitive radiation treatment at our facility between January 01, 1999 and July 31, 2014. All patients who underwent MRI of the pelvis or prostate within 5 years prior to treatment were included in the MRI cohort. The American Urological Symptom Score (AUA) and Rectal Assessment Scale (RAS) were used to measure GU and GI toxicity, respectively. We compared the toxicity profile of patients in our MRI cohort to a comparable cohort of patients who did not receive pre-treatment MRI. Results: 1085 patients (211 with MRI) were analyzed. Median follow-up was 30 months. Mean increase from baseline in AUA scores at 6 months was 3.58 for the MRI cohort and 5.04 for the comparison cohort (p = 0.017). RAS scores were not significantly different between the MRI and comparison cohorts at 6 months (mean increase: 0.62 vs. 0.77, p = 0.662). AUA scores returned to baseline after 6 months in the MRI cohort and after 12 months in the comparison cohort. RAS scores returned to baseline after 12 months in the MRI cohort but never returned to baseline in the comparison cohort. Biochemical failure rates were not significantly different between the MRI cohort and comparison cohort (86.3% vs. 91.1%, p = 0.083). Conclusions: Pre-treatment MRI was associated with significantly less GU and GI toxicity. These results may be influenced by more advanced disease and higher use of hormonal therapy in the MRI cohort. Future prospective studies in a risk-matched cohort are required to validate these findings.

Long-Term Quality of Life in Prostate Cancer Patients Treated with Cesium-131

Prostate brachytherapy (PB) as monotherapy or in combination with external beam radiotherapy (EBRT) represents a curative treatment option for men with prostate cancer. Several radioactive isotopes are approved for use in prostate brachytherapy. Among these, Cesium-131 is the newest to market and has the shortest half-life, a property which gives it dosimetric advantages. Little data exists as to the long-term quality of life (QoL) in patients treated with Cs-131. We identified the first 272 patients treated at our institution with Cs-131, all of whom were treated greater than 5 years ago. Patients were treated between September 2006 and October 2010. These patients were asked to fill out an Expanded Prostate Cancer Index Composite (EPIC) QoL questionnaire and American Urological Association Symptom Score (AUASS) survey before treatment and at each of their follow-up appointments. EPIC scores were reported on a normalized scale from 0-100 (with higher score representing better QoL) for the following categories: Urinary Summary (US), Urinary Function (UF), Urinary Bother (UB), Urinary Incontinence (UI), Urinary Irritation/Obstruction (UIO), Bowel Summary (BS), Bowel Function (BF), and Bowel Bother (BB). AUA scores were reported on a scale of 0-35 (with higher scores representing worse symptomatology). We compared patients’ EPIC and AUA scores at baseline to those at 5-yrs post-treatment. Mean scores were compared using a paired-samples t-test. Clinically significant improvement or worsening in QoL was defined as a change of 10 or more points in EPIC score or 3 or more in AUA score. At 5-yrs of follow-up, 129 patients (47%) had completed both EPIC and AUA questionnaires and one additional patient completed AUA only. Of these 130 patients, median age was 65 (Interquartile range =61-71), 28% had EBRT prior to PB, risk groups were: 40% low-risk; 51% intermediate-risk; 9% high-risk, and 18% received hormonal therapy. Baseline mean EPIC scores were as follows: US=86.7, UF=93.5, UB=82.0, UI=90.8, UIO=85.9, BS=91.5, BF=92.2, BB=90.8. Baseline mean AUA score was 6.9. Average changes in scores at 5-yrs were as follows: US=0.30 (p=0.78), UF=-1.33 (p=0.20), UB=1.51 (p=0.28), UI=-3.25 (p=0.02), UIO=1.98 (p=0.08), BS=-0.07 (p=0.94), BF=-0.26 (p=0.77), BB=-0.11 (p=0.93), AUA=0.18 (p=0.72). The percent of patients with a clinically significant worsening of symptomatology were: US=18%, UF=19%, UB=22%, UI=24%, UIO=14%, BS=13%, BF=16%, BB=17%, AUA=30%. The percent of patients with a clinically significant improvement of symptomatology were: US=15%, UF=14%, UB=27%, UI=15%, UIO=21%, BS=16%, BF=15%, BB=19%, AUA=26%. Our results demonstrate minimal long-term urinary or bowel toxicity with Cs-131 prostate brachytherapy. There were no significant long-term differences in EPIC Urinary Summary score, EPIC Bowel Summary score, or AUA symptom score. As population-based means tend to underestimate individual effects, our conclusion is further validated by the small absolute difference in the rates of clinical improvement and worsening (<10% for all variables).

Quantification of Long-term Stability and Specific Relief of Lower Urinary Tract Symptoms (LUTS) After Robot-assisted Radical Prostatectomy

To assist in preoperative counseling by assessing long-term changes in American Urological Association symptom scores (AUAss) and lower urinary tract symptom (LUTS)-related quality of life (QOL) in patients undergoing robot-assisted radical prostatectomy (RARP). RARP was performed on 666 men by one surgeon from 2002 to 2007 at a single institution. AUAss and QOL were queried preoperatively and at 3, 9, 15, 24-48, 60-84, and 96+ months postoperatively. LUTS subgroups were compared pre-/postsurgery using univariate and multivariate statistics. The mean and median follow-up for all responders was 3.0 and 2.4 years. Pad-free continence at 12 months was 89%. A subset of 174 men reported preoperative and long-term responses; average follow-up was 5.8 years (range 4.0-10.3 years). AUAss for all men declined from baseline to 5 years by 3.7 (8.6 to 4.8) whereas QOL/Bother scores decreased by 0.5 (1.7 to 1.2) (all P < .05). Men with baseline mild LUTS remained clinically unchanged with long-term AUAss. Individuals with moderate and severe preoperative LUTS had marked improvements in AUA and QOL scores (all P ≤ .05). Men with mild LUTS have short-term increases in AUAss but most return to baseline and are stable at 5 years. Benefits were found for men with preoperative moderate and severe LUTS in that 63% had significant QOL improvements and 68% reduced their AUAss to mild LUTS, persisting years after RARP. This study suggests that certain patients with preoperative urinary symptoms and bother may experience improvements in LUTS and associated QOL after RARP.

PD30-07 QUANTITATION OF LONG TERM STABILITY AND SPECIFIC RELIEF OF LOWER URINARY TRACT SYMPTOMS (LUTS) AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II1 Apr 2016PD30-07 QUANTITATION OF LONG TERM STABILITY AND SPECIFIC RELIEF OF LOWER URINARY TRACT SYMPTOMS (LUTS) AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY Adam Gordon, Douglas Skarecky, Kathyrn Osann, Harleen Dhaliwal, Blanca Morales, and Thomas Ahlering Adam GordonAdam Gordon More articles by this author , Douglas SkareckyDouglas Skarecky More articles by this author , Kathyrn OsannKathyrn Osann More articles by this author , Harleen DhaliwalHarleen Dhaliwal More articles by this author , Blanca MoralesBlanca Morales More articles by this author , and Thomas AhleringThomas Ahlering More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.538AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The primary goal of radical prostatectomy (RP) is cancer control, but intuitively it is also an incidental treatment for LUTS relief by removing obstructive prostatic symptoms, but at what cost is it to men with mild LUTS? This study assesses long-term changes in AUA symptom scores (AUAss) in patients after robot-assisted RP (RARP). METHODS RARP was performed on 666 men, by one surgeon from 2002-2007 at a single institution. I-PSS were queried preoperatively and at 3, 9, 15, 24-48, 60-84, and 96+ months postoperatively. 174 men reported preoperative and long-term responses, average FU of 5.8 years (Range 4.0- 10.3 Yrs). RESULTS The average follow up for all men was 3.0 years and pad free continence at 12 months was 89%. Table 1 shows the baseline demographics of respondents is not significantly different from non-respondents. AUAss for all men declined from baseline to 5 Years by 3.7 (8.6 to 4.8), while QOL/Bother scores decreased by 0.5 (1.7 to 1.2), all p < .05. Men with mild LUTS remained statistically and clinically unchanged at 5 years in respect to preoperative AUA scores. In contrast, individuals with moderate/severe preoperative LUTS markedly declined in AUA and QOL scores, all p ≤ 0.05, Figure 1. Long-term improvements in each individual AUA category are shown for the long-term men (5+years) across the 3 LUTS groups, Figure 2. CONCLUSIONS Men with mild LUTS have short term increases in AUA but return to baseline IPSS and are stable at 5 years. Benefits were found for men with preoperative moderate/severe LUTS in that 63% had significant QOL improvements, and 68% reduced their AUA scores to mild LUTS, persisting years after RARP. Men should be counseled that RARP confers a significant long-term benefit in men with moderate/severe AUAss, improving LUTS and QOL. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e714 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Adam Gordon More articles by this author Douglas Skarecky More articles by this author Kathyrn Osann More articles by this author Harleen Dhaliwal More articles by this author Blanca Morales More articles by this author Thomas Ahlering More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Long-term Effect of Definitive, High-Dose IG-IMRT on Urinary Function in Patients With High AUA Scores Prior to Treatment

Many patients with prostate cancer have moderate to severe urinary symptoms prior to treatment. Patients treated with radiation therapy often have a short term increase in their urinary symptoms, but the long term effects are less clear. Moderately to highly symptomatic patients are generally felt to be poor candidates for brachytherapy. We examined the change in AUA symptom and Bother scores with time in a cohort of patients who were moderately or highly symptomatic prior to definitive radiation therapy.

1006 LONG TERM IMPROVEMENT OF UROFLOWMETRY, AUA, AND QOL SCORES AFTER ROBOTIC ASSISTED RADICAL PROSTATECTOMY (RARP) PERSISTS AFTER 5 YEARS

You have accessJournal of UrologyProstate Cancer: Localized (IV)1 Apr 20131006 LONG TERM IMPROVEMENT OF UROFLOWMETRY, AUA, AND QOL SCORES AFTER ROBOTIC ASSISTED RADICAL PROSTATECTOMY (RARP) PERSISTS AFTER 5 YEARS Thomas Ahlering, Adam Gordon, Harleen Dhaliwal, Blanca Morales, and Douglas Skarecky Thomas AhleringThomas Ahlering Orange, CA More articles by this author , Adam GordonAdam Gordon Orange, CA More articles by this author , Harleen DhaliwalHarleen Dhaliwal Orange, CA More articles by this author , Blanca MoralesBlanca Morales Orange, CA More articles by this author , and Douglas SkareckyDouglas Skarecky Orange, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.590AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES No studies to date have documented changes in uroflowmetry and AUA symptom scores (AUAss) in patients after long term RARP ∼5 years. METHODS RARP was performed in 79 men, by one surgeon (TA) from 2002-2007, and AUAs and Bother scores collected for all men at preOP and Long term follow up (FU), at average FU of 5.7 years (Range 4.0- 9.4 Yrs). Uroflowmetric PFR (Peak Flow Rates), PVR (Post Void Residual) and Voided volume (VV), N=105, were evaluated pre/post at average 4.8 years (range 3.0 - 9.7 Yrs). Men were asked to come to clinic visits with a full bladder. Only voided volumes of ≥150cc were included for uroflowmetry (Dantec), and all test strips were manually reviewed for voiding artifacts. RESULTS Total AUAs for all men declined at ∼5 Yrs by 3.8 (8.7 to 4.9) while the bother score decreased by 0.5 (1.7 to 1.2), all p < .05. Average age was 62.0 (Range 43-80) and Pad free continence at 5 years was 88%. Table one illustrates that men with mild LUTS remained clinically unchanged at 5 years in respect to preoperative AUA scores, except for a small increase in urgency. In contrast, Individuals with moderate/severe preop LUTS markedly declined in AUA and QOL Bother scores, all p ≤ 0.05, except urgency. Notably at long term FU, Peak flow rates increased 1-2 fold across all groups, and PVR decreased significantly as well, while VV remained stable. CONCLUSIONS Men with preoperative moderate/severe AUAss had significant PFR and QOL improvements, reduction in AUA scores and PVR, as well as stable volume capacities, all persisting years after RARP. Men should be counseled that RARP confers a very significant long term benefit in men with mod/severe AUAs, improving LUTS and uroflowmetric quality of life. Men with mild AUAss returned to similar preoperative AUAs and likewise had significantly improved uroflowmetric QOL. LUTS (AUAss) Mild (0-7) Moderate to Severe (8-30) Pre Post P-Value Pre Post P-Value N 47 (59%) 32 (41%) Age (Years) 60.5 66.0 61.6 66.9 Follow Up (Years) 4.9 4.7 Pad Free Continence 91 % 87 % Body Mass Index 26.0 26.2 Prostate Weight 50.3 50.8 Peak Flow Rate (PFR) 20.0 36.2 <.001 13.6 30.6 <.001 Post Void Residual (PVR) 108 34 <.001 127 22 <.001 Voided Volume (VV) 457 395 .09 365 355 .89 AUA Total 4.0 4.3 .78 12.5 5.5 <.001 Bother Score 1.1 1.0 .07 2.0 1.3 .02 Residual 0.5 0.7 .35 1.5 0.5 <.001 Frequency 1.1 1.1 .69 2.5 1.2 <.001 Intermittency 0.5 0.3 .42 1.7 0.6 .003 Urgency 0.3 0.7 .01 1.5 1.0 .11 Weak Stream 0.6 0.2 .02 2.3 0.5 <.001 Straining 0.2 0.1 .44 0.9 0.3 .02 Nocturia 1.1 1.2 .77 1.9 1.4 .05 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e413 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thomas Ahlering Orange, CA More articles by this author Adam Gordon Orange, CA More articles by this author Harleen Dhaliwal Orange, CA More articles by this author Blanca Morales Orange, CA More articles by this author Douglas Skarecky Orange, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Baseline Symptom Score and Flow Rate Can Predict Failure of Medical Treatment of Lower Urinary Tract Symptoms: Prospective 12-year Follow-up Study

To assess predictors of failure of medical treatment of lower urinary tract symptoms (LUTS) and evaluate long-term outcome. Between January 1993 and September 1994, 178 men referred with LUTS were prospectively recruited. Assessments included maximum urine flow (Qmax), postvoiding residuals (PVR), transrectal ultrasound (TRUS) prostate volumes, American Urological Association symptom score, and validated quality of life (QOL) and bother scores. Treatment failure was defined as need for transurethral resection of the prostate (TURP). Data were collected at baseline, with final follow-up at 12 years. Univariate and multivariate analyses used Kaplan-Meier and the Cox proportional hazards regression model, respectively, to assess covariates on risk of failure and independent variable prognostic values. Median follow-up was 7.9 years (range, 0-12 years). The mean QOL baseline score of 7.1 improved to 3.6 at 6 years and to 3.3 at 12 years (P <.05 for all). Fifty patients (28%) underwent TURP, with 36 undergoing TURP within 3 years. By univariate analysis, Qmax, AUA and bother scores, and PVR were significantly associated with treatment failure. Independent predictors of failure by multivariate Cox regression were Qmax (>15 vs <15 mL/s; hazard ratio, 3.37; 95% confidence interval, 1.74-6.52; P <.0001) and bother score (<13 vs >13; hazard ratio, 2.37; 95% confidence interval, 1.29-4.35; P = .005). At 12 years, AUA, QOL, and bother scores statistically improved compared with baseline (13 vs 8, 10 vs 6, and 5 vs 2, respectively). Limitations included attrition bias from nonresponders. The beneficial effect of medical treatment persisted for up to 12 years. Treatment is more likely to fail within the first 3 years in patients with low baseline Qmax and high bother scores.

Clinical Study of Chandraprabhavati In Benign Prostatic Hyperplasi

ObjectivenbspTo evaluate the efficacy of Chandraprbha vati in symptomatic BPH casesMaterial and Methods-nbsp480 patients suffering from BPH were screened and 50 patients who fit into the criteria were taken for the study they were analyzed with AUA score each of the patient was gievn chandraprabha vati 400mg 1 tid for 12 wks. Clinical features were assessed after 12 wks and follow up done after 6 months.Results-nbspOut of 50 patients 13 cured of symptoms 16 significatn reduction in symptoms 7 reffered for intervention in 1 symptoms worsened 8 lost for follow up.Conclusion-nbspChandraprabhavati helps in satisfactory resolution of symptoms in prostatic hypertrophy patients with lower AUA Scores and lesser residual volumes.