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. 2014 Oct 21:4:290.
doi: 10.3389/fonc.2014.00290. eCollection 2014.

Improved irritative voiding symptoms 3 years after stereotactic body radiation therapy for prostate cancer

Zaker Rana  1 , Robyn A Cyr  1 , Leonard N Chen  1 , Brian S Kim  1 , Rudy A Moures  1 , Thomas M Yung  1 , Siyuan Lei  1 , Brian T Collins  1 , Simeng Suy  1 , Anatoly Dritschilo  1 , John H Lynch  2 , Sean P Collins  1
Affiliations

Improved irritative voiding symptoms 3 years after stereotactic body radiation therapy for prostate cancer

Zaker Rana et al. Front Oncol. .

Abstract

Background: Irritative voiding symptoms are common in elderly men and following prostate radiotherapy. There is limited clinical data on the impact of hypofractionated treatment on irritative voiding symptoms. This study sought to evaluate urgency, frequency, and nocturia following stereotactic body radiation therapy (SBRT) for prostate cancer.

Methods: Patients treated with SBRT monotherapy for localized prostate cancer from August 2007 to July 2011 at Georgetown University Hospital were included in this study. Treatment was delivered using the CyberKnife(®) with doses of 35-36.25 Gy in five fractions. Patient-reported urinary symptoms were assessed using the International Prostate Symptom Score (IPSS) before treatment and at 1, 3, 6, 9, and 12 months post-treatment and every 6 months thereafter.

Results: Two hundred four patients at a median age of 69 years received SBRT with a median follow-up of 4.8 years. Prior to treatment, 50.0% of patients reported moderate to severe lower urinary tract symptoms (LUTS) and 17.7% felt that urinary frequency was a moderate to big problem. The mean prostate volume was 39 cc and 8% had prior procedures for benign prostatic hyperplasia. A mean baseline IPSS-irritative (IPSS-I) score of 4.8 significantly increased to 6.5 at 1 month (p < 0.0001), however returned to baseline at 3 months (p = 0.73). The IPSS-I score returned to baseline in 91% of patients by 6 months and 96% of patients by 2 years. Transient increases in irritative voiding symptoms were common at 1 year. The mean baseline IPSS-I score decreased to 4.4 at 24 months (p = 0.03) and 3.7 at 36 months (p < 0.0001). In men with moderate to severe LUTS (IPSS ≥ 8) at baseline, the mean IPSS-I decreased from a baseline score of 6.8-4.9 at 3 years post-SBRT. This decrease was both statistically (p < 0.0001) and clinically significant (minimally important difference = 1.45). Only 14.6% of patients felt that urinary frequency was a moderate to big problem at 3 years post-SBRT (p = 0.23).

Conclusion: Treatment of prostate cancer with SBRT resulted in an acute increase in irritative urinary symptoms that peaked within the first month post-treatment. Irritative voiding symptoms returned to baseline in the majority of patients by 3 months post-SBRT and were actually improved from baseline at 3 years post-SBRT.

Keywords: CyberKnife; IPSS; SBRT; irritative; overactive bladder; prostate cancer.

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Figures

Figure 1
Figure 1
IPSS-irritative subscores over the 36 months of follow-up stratified by baseline LUTS. (A) Mean IPSS-irritative score for all patients. (B) Mean values of patients with a mild baseline LUTS (IPSS < 8, n = 102). (C) Mean values of patients with a moderate to severe baseline LUTS (IPSS ≥ 8, n = 102). Changes in scores that are statistically significant different from baseline are marked with an asterisk (*). Thresholds for clinically significant changes in scores (1/2 standard deviation above and below the baseline) are marked with dashed lines. IPSS-irritative scores range from 0 to 15 with lower values representing a more favorable outcome.
Figure 2
Figure 2
Irritative voiding symptoms following SBRT for prostate cancer. (A) Time to IPSS-I resolution was determined by the number of months it took for the IPSS-I score to return to within one point of the baseline score. (B) Percent of patients utilizing alpha-antagonists at each time point.
Figure 3
Figure 3
Nocturia following SBRT for prostate cancer: (nocturia was defined as urinating ≥2 times per night).
See this image and copyright information in PMC

References

    1. Wein AJ, Rovner ES. Definition and epidemiology of overactive bladder. Urology (2002) 60:7–12;discussion12.10.1016/S0090-4295(02)01784-3 - DOI - PubMed
    1. Milsom I, Stewart W, Thuroff J. The prevalence of overactive bladder. Am J Manag Care (2000) 6:S565–73. - PubMed
    1. Sexton CC, Coyne KS, Kopp ZS, Irwin DE, Milsom I, Aiyer LP, et al. The overlap of storage, voiding and postmicturition symptoms and implications for treatment seeking in the USA, UK and Sweden: EpiLUTS. BJU Int (2009) 103(Suppl 3):12–23.10.1111/j.1464-410X.2009.08369.x - DOI - PubMed
    1. Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med (2008) 358:1250–61.10.1056/NEJMoa074311 - DOI - PubMed
    1. Abrams P, Kelleher CJ, Kerr LA, Rogers RG. Overactive bladder significantly affects quality of life. Am J Manag Care (2000) 6:S580–90. - PubMed

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