Androgen deprivation-mediated cytoreduction before interstitial brachytherapy for prostate cancer does not abrogate the elevated risk of urinary morbidity associated with larger initial prostate volume

Petit, Joshua H.; Gluck, Clifford; Kiger, W.S.; Laury Henry, D.; Karasiewicz, Carol; Talcott, James A.; Berg, Solomon; Holupka, Edward J.; Kaplan, Irving D.

doi:10.1016/j.brachy.2007.08.007

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Volume 6, Issue 4 , Pages 267-271, October 2007

Androgen deprivation-mediated cytoreduction before interstitial brachytherapy for prostate cancer does not abrogate the elevated risk of urinary morbidity associated with larger initial prostate volume

Joshua H. Petit
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Corresponding author. Department of Radiation Oncology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215. Tel.: +1-617-667-2345; fax: +1-617-667-4990.
Clifford Gluck
- Department of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
W.S. Kiger III
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
D. Laury Henry
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Carol Karasiewicz
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
James A. Talcott
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Solomon Berg
- Department of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Edward J. Holupka
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Irving D. Kaplan
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

Received 3 April 2007; received in revised form 12 July 2007; accepted 23 August 2007. published online 25 October 2007.

Abstract

Purpose

We examined whether prostate volume reduction after a short course of androgen deprivation (AD) lowered the risks of acute and chronic urinary morbidity related to radioactive seed implantation for low-risk prostate cancer.

Methods and materials

Eighty-one patients received AD for cytoreduction before interstitial brachytherapy alone. Urinary morbidity was carefully assessed for all patients during a median followup of 53 (range, 23–78) months after treatment. Outcomes were then compared with those of a control group of 81 patients who were matched 1:1 based on identical prostate volume measured at the time of radioactive seed implant, but who had not received AD.

Results

Despite effective cytoreduction (median, 30% prostate volume reduction) with AD, prolonged catheterization was required significantly more often for patients who had received AD when compared with the control group of patients who were implanted at identical prostate volumes but who had not received AD (27% vs. 9%, p=0.02). This finding remained statistically significant on multivariate analysis (p=0.04). Surgical intervention (9% vs. 4%, p=0.09) and subsequent urinary incontinence (4% vs. 1%, p=0.16) were also more frequent among patients who had received AD when compared with implant volume-matched controls.

Conclusions

Patients who achieved smaller prostate volumes through the use of AD maintained a significantly elevated risk (threefold) for urinary complications, commensurate with their initially large prostate volume, when compared with a control group of patients who were implanted at identical prostate volumes but who had not received AD. Therefore, patients presenting with larger prostate glands that would warrant a short course of AD before implant should be counseled accordingly when discussing options for local therapy.

Keywords: Androgen deprivation, Brachytherapy, Morbidity, Prostate cancer