- Email: [email protected]
1203 PREDICTORS OF URINARY INCONTINENCE FOLLOWING PROSTATE BRACHYTHERAPY
Vol. 189, No. 4S, Supplement, Monday, May 6, 2013
effective dose (BED). Estimates for cause specific (CSS) and all cause survival (ACS) were determined by Kaplan Meier method with comparisons by logistic regression and Cox proportions hazard rates. RESULTS: The 10 and 15-year survival rates were 98.1% and 94.1% (CSS) and 86.8% and 57% (ACS). 10 and 15-year CSS by NCCN risk groups were 99.8% and 96.3% (1); 97.7% and 97.5% (2), and 92.5% and 85.2% (3). Gleason score (GS), PSA and clinical stage (CS) were significant predictors of CSS on univariate analysis (p⬍0.001), while HT and BED were not. Cox regression revealed GS (p⬍0.001) and CS (p⫽0.002) as significant. At the time of this analysis 37 (2.2%) men had died of prostate cancer. Significant variables affecting ACS included HT (p⫽0.009), diabetes (0.016), atrial fibrillation (0.008) and heart disease (p⫽0.03). A history of smoking, CAD, alcohol use, asthma, other cancer, HBP, stokes and emphysema did not influence ACS. Cox regression revealed HT (p⫽0.007, HR 1.43), diabetes (p⫽0.021, HR 1.74), atrial fib (p⫽0.027, HR 3.09) and heart disease (p⫽0.053, HR 1.94) as significant. HT decreased ACS at 15 years from 60.3% to 54.9% (p⫽0.009). There was no decrease in ACS in patients given HT for ⬍ 6 months (p⫽0.140) vs. ⬎ 6 months (p⫽0.005). This difference persisted in younger (age ⬍ 66, p⫽0.017) and older men (p⫽0.05). 236 (14.2%) men had died at the time of this analysis. CONCLUSIONS: PB yields favorable 15-year CSS, especially in high risk patients. ACS is less in patients with preexisting diabetes, atrial fibrillation and heart disease. The use of HT for longer than 6 months has a negative effect on ACS even in younger patients without an apparent beneficial effect on CSS. Source of Funding: None
1203 PREDICTORS OF URINARY INCONTINENCE FOLLOWING PROSTATE BRACHYTHERAPY Michael Leapman*, Nelson Stone, Steven Mock, Simon Hall, Richard Stock, New York, NY INTRODUCTION AND OBJECTIVES: To define the long-term incidence and risk factors in the development of urinary incontinence (UI) following prostate brachytherapy. METHODS: 2,370 men were identified who underwent permanent interstitial PB with or without external beam radiation (EBRT) for the diagnosis of prostate cancer. Baseline International Prostate Symptom Score (IPSS) quality of life (QOL), and history of prior TURP were assessed prior to treatment. All patients received one month postbrachytherapy dosimetry. Dose delivered to 30% of prostatic urethra was available for 81.9% of patients. Patients with less than two years follow-up, or subsequent TURP after brachytherapy were excluded from analysis. The relationship between age, prostate volume, preimplantation IPSS, race, Gleason score, biologically effective dose (BED), clinical stage, initial PSA, use of androgen deprivation therapy (ADT), EBRT, isotope, biochemical control, prior TURP, and the development of urinary incontinence (pad usage) was investigated. RESULTS: Patients were followed for a median of 6.5 years (IQR 4.1-9.3). 117 men underwent TURP prior to therapy. UI was reported in 80 individuals (3.4%), at a median of 1.5 years (IQR 0.4-4.0). 56 men (2.4%) required one pad per day, 15 (0.63%) reported wearing two pads per day, 8 (0.34%) reported three pads per day and one patient reported using four pads per day. On univariate analysis the factors associated with UI were: history of TURP prior to brachytherapy (p⫽0.001), pre-implantation IPSS greater than 7 (p⫽0.029), use of ADT (p⫽0.011), Palladium103 isotope(p⫽0.014), prostate size greater than 40cm3 (p⫽0.046), and EBRT (p⬍0.0001), (table). Higher BED was not significant (p⫽0.461). On binary multivariate analysis, EBRT (OR 5.64, 95% CI 1.76-17.9, p⬍0.004) and TURP prior to brachytherapy (OR 4.41, 95% CI 2.09-9.31, p⬍0.001) were predictive of incontinence. CONCLUSIONS: Overall urinary incontinence post-brachytherapy is low. Patients with history of TURP prior to brachytherapy, and those receiving EBRT are at greater risk for developing urinary incontinence following prostate brachytherapy.
THE JOURNAL OF UROLOGY姞
e493
Incidence of urinary incontinence after prostate brachytherapy by significant dichotomous exploratory variables Number with P-value incontinence Total Proportion (X2) With ADT 55 1,298 4.2% 0.011 Without ADT
25
1,072
2.3%
Pre-implant IPSS ⬍ 7
31
1,186
2.6%
Pre-implant IPSS ⱖ7
44
1,023
4.3%
Prostate vol ⬍ 40cm3
28
1,044
2.7%
Prostate vol ⱖ 40cm3
51
1,203
4.2%
TURP prior to implant
10
117
8.5%
No prior TURP
70
2,253
3.1%
Iodine125 isotope
32
1,268
2.5%
Palladium103 isotope
48
1,102
4.4%
EBRT
46
875
5.3%
Without EBRT
34
1,495
2.3%
Gleason score ⱕ6
43
1,533
2.8%
Gleason score ⱖ7
37
837
4.4%
0.029 0.046 0.001 0.014 ⬍0.001 0.037
Source of Funding: None
1204 LONG-TERM IMPACT ON ERECTILE FUNCTION AFTER BRACHYTHERAPY FOR PROSTATE CANCER Luis Campos Pinheiro, Joa˜o Magalha˜es Pina*, Joa˜o Varregoso, Rosa´rio Vicente, Justo Ugidos, Nuno Teixeira, Taˆnia Oliveira e Silva, Alberto Matos Ferreira, Lisbon, Portugal INTRODUCTION AND OBJECTIVES: Our purpose is to assess potency preservation among patients with clinically localized and locally advanced prostate cancer (Pca) submitted to prostate brachytherapy (BT) alone, or in association with external beam radiotherapy (EBRT) and/or androgen deprivation therapy (ADT); to assess the effect of clinical, treatment and dosimetric parameters on penile erectile function. METHODS: Since 2000, 593 patients with T1-T3 Pca were treated with BT (I125, prescription dose 160 Gy) alone (82,7%) or combined with 6 months of ADT (9,2%). 3,7% of patients were treated with BT (I125, prescription dose 110 Gy) associated with EBRT (45 Gy). BT plus EBRT and 9 moths of ADT was used in 4% of patients. Patients completed a self administered Brief Sexual Function Inventory (BSFI) questionnaire before implant and at each follow-up visit. Erectile item ranges from 0-12. Potency was considered when scoreⱖ4 (minimum score which allows for satisfactory erections) with or without the use of iPDE5. Only initially potent patients were included. Patients with biochemical failure were excluded. A minimum follow-up of 1 year was required. Biological effective dose (BED) scale was used, in order to standardise the radiation dose administered by implant only or combined with EBRT. Potency rate was calculated using the Kaplan-Mayer method and log-rank test. Cox regression was used for multivariable analysis. Statistical significance was considered when p⬍0,05. RESULTS: The overall 48-month potency preservation rate was 71,0%. This was 73,4% for BT alone, 65,5% for BT with ADT, 54,5% for BT with EBRT and 50% for the trimodal treatment (p⫽0,008). Age influenced potency preservation in both univariate and multivariate analysis, with a rate of 95,5% for men ⬍50 yr, 81,8% for age 50-60, 66,7% between 60 and 70, and 59,5% for men ⬎70 (p⬍0,001). 72,6% of men treated without ADT remained potent, compared with 60,8% when ADT was used. (p⫽0,037). Total BED dose showed no statistical significance. However, when compared implant alone group with the EBRT one a significant difference was shown, favoring the first group (p⫽0,001) Gleason score, prostate volume, tumoral staging or PSA value showed no correlation with post-treatment potency preservation both on univariate and multivariate analysis. CONCLUSIONS: Over 70% of patients undergoing BT remain potent after 48 months. Younger patients (⬍50 yr) showed 95,5% potency preservation rate. Increasing initial age at implant and the use
effective dose (BED). Estimates for cause specific (CSS) and all cause survival (ACS) were determined by Kaplan Meier method with comparisons by logistic regression and Cox proportions hazard rates. RESULTS: The 10 and 15-year survival rates were 98.1% and 94.1% (CSS) and 86.8% and 57% (ACS). 10 and 15-year CSS by NCCN risk groups were 99.8% and 96.3% (1); 97.7% and 97.5% (2), and 92.5% and 85.2% (3). Gleason score (GS), PSA and clinical stage (CS) were significant predictors of CSS on univariate analysis (p⬍0.001), while HT and BED were not. Cox regression revealed GS (p⬍0.001) and CS (p⫽0.002) as significant. At the time of this analysis 37 (2.2%) men had died of prostate cancer. Significant variables affecting ACS included HT (p⫽0.009), diabetes (0.016), atrial fibrillation (0.008) and heart disease (p⫽0.03). A history of smoking, CAD, alcohol use, asthma, other cancer, HBP, stokes and emphysema did not influence ACS. Cox regression revealed HT (p⫽0.007, HR 1.43), diabetes (p⫽0.021, HR 1.74), atrial fib (p⫽0.027, HR 3.09) and heart disease (p⫽0.053, HR 1.94) as significant. HT decreased ACS at 15 years from 60.3% to 54.9% (p⫽0.009). There was no decrease in ACS in patients given HT for ⬍ 6 months (p⫽0.140) vs. ⬎ 6 months (p⫽0.005). This difference persisted in younger (age ⬍ 66, p⫽0.017) and older men (p⫽0.05). 236 (14.2%) men had died at the time of this analysis. CONCLUSIONS: PB yields favorable 15-year CSS, especially in high risk patients. ACS is less in patients with preexisting diabetes, atrial fibrillation and heart disease. The use of HT for longer than 6 months has a negative effect on ACS even in younger patients without an apparent beneficial effect on CSS. Source of Funding: None
1203 PREDICTORS OF URINARY INCONTINENCE FOLLOWING PROSTATE BRACHYTHERAPY Michael Leapman*, Nelson Stone, Steven Mock, Simon Hall, Richard Stock, New York, NY INTRODUCTION AND OBJECTIVES: To define the long-term incidence and risk factors in the development of urinary incontinence (UI) following prostate brachytherapy. METHODS: 2,370 men were identified who underwent permanent interstitial PB with or without external beam radiation (EBRT) for the diagnosis of prostate cancer. Baseline International Prostate Symptom Score (IPSS) quality of life (QOL), and history of prior TURP were assessed prior to treatment. All patients received one month postbrachytherapy dosimetry. Dose delivered to 30% of prostatic urethra was available for 81.9% of patients. Patients with less than two years follow-up, or subsequent TURP after brachytherapy were excluded from analysis. The relationship between age, prostate volume, preimplantation IPSS, race, Gleason score, biologically effective dose (BED), clinical stage, initial PSA, use of androgen deprivation therapy (ADT), EBRT, isotope, biochemical control, prior TURP, and the development of urinary incontinence (pad usage) was investigated. RESULTS: Patients were followed for a median of 6.5 years (IQR 4.1-9.3). 117 men underwent TURP prior to therapy. UI was reported in 80 individuals (3.4%), at a median of 1.5 years (IQR 0.4-4.0). 56 men (2.4%) required one pad per day, 15 (0.63%) reported wearing two pads per day, 8 (0.34%) reported three pads per day and one patient reported using four pads per day. On univariate analysis the factors associated with UI were: history of TURP prior to brachytherapy (p⫽0.001), pre-implantation IPSS greater than 7 (p⫽0.029), use of ADT (p⫽0.011), Palladium103 isotope(p⫽0.014), prostate size greater than 40cm3 (p⫽0.046), and EBRT (p⬍0.0001), (table). Higher BED was not significant (p⫽0.461). On binary multivariate analysis, EBRT (OR 5.64, 95% CI 1.76-17.9, p⬍0.004) and TURP prior to brachytherapy (OR 4.41, 95% CI 2.09-9.31, p⬍0.001) were predictive of incontinence. CONCLUSIONS: Overall urinary incontinence post-brachytherapy is low. Patients with history of TURP prior to brachytherapy, and those receiving EBRT are at greater risk for developing urinary incontinence following prostate brachytherapy.
THE JOURNAL OF UROLOGY姞
e493
Incidence of urinary incontinence after prostate brachytherapy by significant dichotomous exploratory variables Number with P-value incontinence Total Proportion (X2) With ADT 55 1,298 4.2% 0.011 Without ADT
25
1,072
2.3%
Pre-implant IPSS ⬍ 7
31
1,186
2.6%
Pre-implant IPSS ⱖ7
44
1,023
4.3%
Prostate vol ⬍ 40cm3
28
1,044
2.7%
Prostate vol ⱖ 40cm3
51
1,203
4.2%
TURP prior to implant
10
117
8.5%
No prior TURP
70
2,253
3.1%
Iodine125 isotope
32
1,268
2.5%
Palladium103 isotope
48
1,102
4.4%
EBRT
46
875
5.3%
Without EBRT
34
1,495
2.3%
Gleason score ⱕ6
43
1,533
2.8%
Gleason score ⱖ7
37
837
4.4%
0.029 0.046 0.001 0.014 ⬍0.001 0.037
Source of Funding: None
1204 LONG-TERM IMPACT ON ERECTILE FUNCTION AFTER BRACHYTHERAPY FOR PROSTATE CANCER Luis Campos Pinheiro, Joa˜o Magalha˜es Pina*, Joa˜o Varregoso, Rosa´rio Vicente, Justo Ugidos, Nuno Teixeira, Taˆnia Oliveira e Silva, Alberto Matos Ferreira, Lisbon, Portugal INTRODUCTION AND OBJECTIVES: Our purpose is to assess potency preservation among patients with clinically localized and locally advanced prostate cancer (Pca) submitted to prostate brachytherapy (BT) alone, or in association with external beam radiotherapy (EBRT) and/or androgen deprivation therapy (ADT); to assess the effect of clinical, treatment and dosimetric parameters on penile erectile function. METHODS: Since 2000, 593 patients with T1-T3 Pca were treated with BT (I125, prescription dose 160 Gy) alone (82,7%) or combined with 6 months of ADT (9,2%). 3,7% of patients were treated with BT (I125, prescription dose 110 Gy) associated with EBRT (45 Gy). BT plus EBRT and 9 moths of ADT was used in 4% of patients. Patients completed a self administered Brief Sexual Function Inventory (BSFI) questionnaire before implant and at each follow-up visit. Erectile item ranges from 0-12. Potency was considered when scoreⱖ4 (minimum score which allows for satisfactory erections) with or without the use of iPDE5. Only initially potent patients were included. Patients with biochemical failure were excluded. A minimum follow-up of 1 year was required. Biological effective dose (BED) scale was used, in order to standardise the radiation dose administered by implant only or combined with EBRT. Potency rate was calculated using the Kaplan-Mayer method and log-rank test. Cox regression was used for multivariable analysis. Statistical significance was considered when p⬍0,05. RESULTS: The overall 48-month potency preservation rate was 71,0%. This was 73,4% for BT alone, 65,5% for BT with ADT, 54,5% for BT with EBRT and 50% for the trimodal treatment (p⫽0,008). Age influenced potency preservation in both univariate and multivariate analysis, with a rate of 95,5% for men ⬍50 yr, 81,8% for age 50-60, 66,7% between 60 and 70, and 59,5% for men ⬎70 (p⬍0,001). 72,6% of men treated without ADT remained potent, compared with 60,8% when ADT was used. (p⫽0,037). Total BED dose showed no statistical significance. However, when compared implant alone group with the EBRT one a significant difference was shown, favoring the first group (p⫽0,001) Gleason score, prostate volume, tumoral staging or PSA value showed no correlation with post-treatment potency preservation both on univariate and multivariate analysis. CONCLUSIONS: Over 70% of patients undergoing BT remain potent after 48 months. Younger patients (⬍50 yr) showed 95,5% potency preservation rate. Increasing initial age at implant and the use