Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar;9(1):48-53.
doi: 10.1016/j.prnil.2020.07.006. Epub 2020 Aug 11.

Radiation-induced haemorrhagic cystitis after prostate cancer radiotherapy: factors associated to hospitalization and treatment strategies

Francesco Sanguedolce  1 , Gemma Sancho Pardo  2 , Asier Mercadé Sanchez  1 , Josep Balaña Lucena  1 , Francesca Pisano  1 , Julio Calderón Cortez  1 , Angelo Territo  1 , Jordi Huguet Perez  1 , Josep Gaya Sopeña  1 , Cristina Esquina Lopez  3 , Alberto Breda  1 , Joan Palou Redorta  1
Affiliations

Radiation-induced haemorrhagic cystitis after prostate cancer radiotherapy: factors associated to hospitalization and treatment strategies

Francesco Sanguedolce et al. Prostate Int. 2021 Mar.

Abstract

Background: Late onset of radiation-induced haemorrhagic cystitis (RHC) after radiation therapy (RT) for prostate cancer (PCa) may present or evolve severely, requiring hospitalization with invasive interventions. In the present study, we have analysed the prevalence and risk factors associated with the onset of RHC.

Methods: From January 2002 to May 2017, 1421 patients undertook RT for PCa as a primary, adjuvant, or salvage treatment option. RHC presented in 5.6% (n = 80) of the patients; the diagnosis was based on clinical and endoscopic characteristics. Variables in observation included patients, tumours, and RT-dosimetry characteristics. Patients with a previous history of bladder cancer were excluded. Univariate (Student t/Chi square) and uni-/multivariate Cox regression analysis were performed; the events and time-points were hospitalization and time-to-event, respectively.

Results: There were 80 patients with a mean age at RT of 70.1 years (SD 6.4), mean time lag to RHC of 43.9 months (SD 37.5). Median Emergency attendance was two and three times for patients without/with hospitalization, respectively. There were in total 64 admissions with invasive treatment required in 26/36 (72.2%) of the patients hospitalised, including transurethral fulguration in 22 and radical cystectomy in 5. Patients at higher risk of hospitalization were those undertaking antiplatelet/anticoagulant treatment (HR:3.30; CI 95%:1.53-3.30; p = 0.002) and those treated with salvage RT with higher bladder volume receiving >70 Gy (bladder V70) (HR:1.03; CI 95%:1.01-1.05; p = 0.027). At receiving operating characteristic analysis, the cutoff for bladder V70 was 29%.

Conclusion: Nearly half of patients presenting RHC may require invasive treatment including cystectomy. Risk factors associated with hospitalization are patients undertaking antiplatelet/coagulant treatment and bladder V70 > 29% in salvage RT patients.

Keywords: Cystitis; Hematuria; Hospitalization; Prostate neoplasm; Radiotherapy; Risk factors.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Diagnostic and therapeutic pathway for patients presenting gross haematuria with past medical history of prostate radiotherapy.
See this image and copyright information in PMC

References

    1. Mottet N.B.J., Briers E., Bolla M., Bourke L., Cornford P., De Santis M., members of the EAU – ESTRO – ESUR –SIOG Prostate Cancer Guidelines Panel . EAU Guidelines Office. Place published: Arnhem; The Netherlands: 2019. EAU – ESTRO – ESUR – SIOG Guidelines on Prostate Cancer.
    1. Network. NCC . 2019. Prostate Cancer (Version 4.2019). NCCN Guidelines®.https://www.nccn.org/professionals/physician_gls/pdf/prostate_blocks.pdf
    1. Cox J.D., Stetz J., Pajak T.F. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) Int J Radiat Oncol Biol Phys. 1995;31(5):1341–1346. doi: 10.1016/0360-3016(95)00060-C. - DOI - PubMed
    1. Smit S.G., Heyns C.F. Management of radiation cystitis. Nat Rev Urol. 2010;7(4):206–214. doi: 10.1038/nrurol.2010.23. - DOI - PubMed
    1. Martinez-Arribas C.M., Gonzalez-San Segundo C., Cuesta-Alvaro P., Calvo-Manuel F.A. Predictors of urinary and rectal toxicity after external conformed radiation therapy in prostate cancer: Correlation between clinical, tumour and dosimetric parameters and radical and postoperative radiation therapy. Actas Urol Esp. 2017;41(10):615–623. doi: 10.1016/j.acuro.2017.03.010. - DOI - PubMed

LinkOut - more resources