PII S0360-3016(99)00525-8 CLINICAL INVESTIGATION Prostate TEMPORAL RESOLUTION OF URINARY MORBIDITY FOLLOWING PROSTATE BRACHYTHERAPY GREGORY S. MERRICK, M.D.,* ² WAYNE M. BUTLER,PH.D.,* JONATHAN H. LIEF,PH.D.,* ‡ AND ANTHONY T. DORSEY, M.S.* *Schiffler Oncology Center, Wheeling Hospital, Wheeling, WV; ² Division of Radiation Oncology & Biophysics, George Washington University Medical Center, Washington, DC; ‡ Wheeling Jesuit University, Wheeling, WV Purpose: To report the short-term urinary morbidity for prostate brachytherapy patients without a preimplant history of a transurethral resection of the prostate gland and who received prophylactic and prolonged -blockers. -blockers may decrease radiation-induced urethritis and increase urinary flow. Multiple clinical and treatment parameters were evaluated to identify factors associated with increased acute urinary morbidity. Materials and Methods: One hundred seventy consecutive patients without a prior history of a transurethral resection of the prostate gland underwent transperineal ultrasound guided prostate brachytherapy for clinical T1c-T3a carcinoma of the prostate gland. For all patients, an -blocker was initiated prior to implantation and continued at least until the international prostate symptom score (IPSS) returned to baseline levels. Clinical parameters evaluated for short-term urinary morbidity included patient age, clinical T stage, preimplant IPSS (obtained within 3 weeks of implantation), and prostate ultrasound volume. Treatment parameters included the utilization of neoadjuvant hormonal manipulation, the utilization of moderate dose external beam radiation therapy before implantation, the choice of isotope, the urethral dose, the total implant activity in millicuries, and a variety of dosimetric quality indicators (D 90 and V 100 /V 150 /V 200 ). Catheter dependency and the duration of -blocker dependency was also evaluated. On average, 11.2 IPSS surveys were obtained for each patient. Results: One hundred fifty of the 170 patients (88.2%) had the urinary catheter permanently removed on day 0. Only one patient required an urinary catheter for > 5 days. Two patients (1.2%) required a subsequent transurethral resection of the prostate gland because of prolonged obstructive/irritative symptoms. To date, no patient has developed an urinary stricture or urinary incontinence. The IPS score on average peaked at 2 weeks following implantation. This score returned to within 1 point of the antecedent value at a median of 6 weeks and a mean of 13.3 weeks. At 26 and 50 weeks, 85% and 56% of the patients, respectively, continued with -blockers. Of the clinical and treatment parameters evaluated for short-term urinary morbidity, only variants of the IPSS such as the maximum, maximum increase, and preimplant IPSS values correlated with time to return to the referent zone with p < 0.05. Conclusion: The return of the IPS score to baseline occurred more rapidly in our series than what has previously been reported. The 1.2% incidence of transurethral resections also compares favorably with the published literature. We believe these results may be due to maintaining the average urethral dose to approximately 115% of the prescribed dose and the prophylactic and long-term use of -blockers. © 2000 Elsevier Science Inc. Prostate brachytherapy, Urinary morbidity, 125 Iodine, 103 Palladium, -Blockers. INTRODUCTION Over the past decade, transperineal ultrasound guided pros- tate brachytherapy has been increasingly utilized as defini- tive management for early stage carcinoma of the prostate gland. The results of prostate brachytherapy have been reported to be as favorable as the most positive radical prostatectomy series with a decreased incidence of urinary incontinence and sexual dysfunction (1–5). In addition, significant rectal injury is rare (6). A paucity of data, how- ever, has been published regarding the short-term urinary morbidity following prostate brachytherapy. Almost all pa- tients experience some degree of urinary irritative/obstruc- tive symptomatology including urinary frequency, dysuria, urgency, interruption of the stream, incomplete voiding, straining, and nocturia; 3%–22% of patients develop acute urinary retention following prostate brachytherapy (4, 7–11). Terk et al. (7) were able to correlate the risk of urinary retention with the preimplant international prostate symptom score (IPSS). A recent controlled study concluded that peri-operative dexamethasone does not significantly alter short-term urinary morbidity (12). The IPSS was developed by the American Urological Association (AUA) in 1992 as a measure of symptomatic relief following prostatectomy for benign prostatic hyper- trophy. The generated score resulted in excellent test-retest Reprint requests to: Gregory S. Merrick, M.D., Schiffler Oncol- ogy Center, Wheeling Hospital, 1 Medical Park, Wheeling, WV 26003-6300; E-Mail: oncology@hgo.net Accepted for publication 23 November 1999. Int. J. Radiation Oncology Biol. Phys., Vol. 47, No. 1, pp. 121–128, 2000 Copyright © 2000 Elsevier Science Inc. Printed in the USA. All rights reserved 0360-3016/00/$–see front matter 121