Pre-treatment genitourinary symptoms can improve after EBRT to the prostate
MedWire News: Prostate cancer patients with pretreatment obstructive urinary symptoms can experience improvement in their urinary function after external beam radiotherapy (EBRT), without increasing their risk for severe genitourinary (GU) toxicity, report US researchers.
Stanley Liauw, from the University of Chicago in Illinois, and colleagues explain that urinary symptom scores can take up to 1 year to return to a patient's baseline functioning, and thus radical prostatectomy is traditionally the first approach considered to avoid post-implant catheterization, and late urinary morbidity.
As reported in the International Journal of Radiation Oncology Biology Physics, Liauw and colleagues examined the nature and severity of post-EBRT urinary dysfunction in 368 prostate cancer patients with moderate-to-severe urinary symptoms, for a median of 40 months.
The men's symptoms were graded according to the International Prostate Symptom Score (IPSS), at baseline, 1 month after treatment, then every 6 months for 2 years, after which follow-up was annual. An IPSS score of 15 or higher at baseline, indicating moderate-to-poor urinary function, was found in 80 (22%) men.
The median IPSS score at baseline was 18 for men with a score of 15 or higher, and 6 for the remaining 288 men with scores of 14 or less.
At first follow-up, the median IPSS score for men with moderate-to-poor urinary function at baseline had improved slightly, decreasing to 17 points. By last follow-up, the median IPSS score for these men had decreased further, to 13.
Furthermore, 79% of 78 men with baseline IPSS scores of 15 or higher and available follow-up data experienced a decline in IPSS score by last follow-up.
Of note, the researchers report that although they observed a 2.3-fold increased risk for Grade 2 or higher GU toxicities for men with a pre-treatment IPSS score of 15 or higher versus those with a score of 14 or lower, there was no significant difference in the incidence of Grade 3 or higher toxicity.
"This difference in Grade 2 toxicity was likely to be primarily because of GU medication use during follow-up," write the researchers, who report that 54% of men with high baseline IPSS scores were taking GU medications at last follow-up.
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By Sarah Guy