Patient assessment of lower urinary tract symptoms using the international prostate symptom score following low-dose-rate prostate brachytherapy



      To correlate changes in urinary patient-reported outcomes including the International Prostate Symptom Score (IPSS), acute urinary retention and urethral stricture with urethral dose in those treated with low dose rate (LDR) prostate brachytherapy.

      Materials and Methods

      Patients treated with prostate LDR between 2012 and 2019 (n=117) completed IPSS urinary symptom assessments prior to treatment and at each follow-up. CT simulation was obtained with urinary catheter 1-month post-implant for dosimetric analysis. 113 patients with pre- and ≥1 post-LDR IPSS score available were analyzed. Urethral dosimetric parameters including U75, U100, U125, U150 and U200 were abstracted from post-implant dosimetry and assessed for association with urinary toxicity using bivariate logistic regression and Spearman correlation. Outcomes included clinically significant change (CSC, defined as 4 or more points or 25% rise above baseline) in IPSS score at 6 and 12 months, acute urinary retention (AUR), and urethral stricture (US).


      89 (79%) patients were treated with LDR monotherapy (145 Gy) and 24 (21%) with LDR boost (110 Gy) with external beam radiation therapy. Twenty (18%) had baseline IPSS ≥15. Median IPSS scores were: baseline 6 (3−12; n=113), 1-month 17 (10−25; n=110), 6 months 12 (7−18; n=77), 1 year 8 (5−14; n=52). CSC-6 was observed in 59 (77%), CSC-12 in 26 (50%), AUR in 12 (11%), and US in 4 (4%). No association was identified between urethral dose parameters and CSC-6, CSC-12, AUR, or US. No correlation between urethral dose and IPSS at 6- and 12-months was identified. The IPSS ≥15 group exhibited lower rates of CSC-12 (13% v. 57%, p=0.05) but not CSC-6 (55% v. 80%, p=0.12).


      We did not find a relationship between urethral dose and IPSS elevation, AUR or US. We did identify a significantly lower change in IPSS at 12 months for those with baseline IPSS ≥15 compared to those with low baseline scores.


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        • Chen R.C.
        • et al.
        Association between choice of radical prostatectomy, external beam radiotherapy, brachytherapy, or active surveillance and patient-reported quality of life among men with localized prostate cancer.
        JAMA. 2017; 317 (p.): 1141-1150
        • Sanda M.G.
        • et al.
        Quality of life and satisfaction with outcome among prostate-cancer survivors.
        N Engl J Med. 2008; 358 (p.): 1250-1261
        • Tomita N.
        • et al.
        International prostate symptom score (IPSS) change and changing factor in intensity-modulated radiotherapy combined with androgen deprivation therapy for prostate cancer.
        Nagoya J Med Sci. 2015; 77 (p.): 637-646
        • Li X.
        • et al.
        Long-term follow-up of International Prostate Symptom Score (IPSS) in men following prostate brachytherapy.
        World J Urol. 2014; 32 (p.): 1061-1066
      1. Network, N.C.C. Prostate Cancer (version 2.2021). Available from:

        • Fischer-Valuck B.W.
        • et al.
        A brief review of low-dose rate (LDR) and high-dose rate (HDR) brachytherapy boost for high-risk prostate.
        Front Oncol. 2019; 9 (p.): 1378
        • Morgan T.M.
        • et al.
        High-dose-rate prostate brachytherapy appears safe in patients with high baseline international prostate symptom scores.
        Brachytherapy. 2019; 18 (p.): 793-799
        • Bosch J.L.
        • et al.
        The long-term relationship between a real change in prostate volume and a significant change in lower urinary tract symptom severity in population-based men: the Krimpen study.
        Eur Urol. 2008; 53 (p.discussion 825-7): 819-825
        • Nath R.
        • et al.
        AAPM recommendations on dose prescription and reporting methods for permanent interstitial brachytherapy for prostate cancer: report of Task Group 137.
        Medical physics,. 2009; 36 (p.): 5310-5322
        • Wallner K.
        • Roy J.
        • Harrison L.
        Dosimetry guidelines to minimize urethral and rectal morbidity following transperineal I-125 prostate brachytherapy.
        Int J Radiat Oncol Biol Phys. 1995; 32 (p.): 465-471
        • Hathout L.
        • et al.
        Dose to the bladder neck is the most important predictor for acute and late toxicity after low-dose-rate prostate brachytherapy: implications for establishing new dose constraints for treatment planning.
        Int J Radiat Oncol*Biol*Physic. 2014; 90 (p.): 312-319
        • Steggerda M.J.
        • et al.
        Is there a relation between the radiation dose to the different sub-segments of the lower urinary tract and urinary morbidity after brachytherapy of the prostate with I-125 seeds?.
        Radiother Oncol. 2013; 109 (p.): 251-255
        • Kittel J.A.
        • et al.
        Long-term efficacy and toxicity of low-dose-rate ¹²⁵i prostate brachytherapy as monotherapy in low-, intermediate-, and high-risk prostate cancer.
        Int J Radiat Oncol Biol Phys. 2015; 92 (p.): 884-893
        • Harris P.A.
        • et al.
        Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42 (p.): 377-381
        • Crook J.M.
        • et al.
        Comparison of health-related quality of life 5 years after spirit: surgical prostatectomy versus interstitial radiation intervention trial.
        J Clin Oncol. 2010; 29 (p.): 362-368
        • Chen C.
        • et al.
        Comparisons of health-related quality of life among surgery and radiotherapy for localized prostate cancer: a systematic review and meta-analysis.
        Oncotarget. 2017; 8 (p.): 99057-99065
        • Salembier C.
        • et al.
        Tumour and target volumes in permanent prostate brachytherapy: A supplement to the ESTRO/EAU/EORTC recommendations on prostate brachytherapy.
        Radiother Oncol. 2007; 83 (p.): 3-10
        • Veccia A.
        • et al.
        Impact of post-implant dosimetric parameters on the quality of life of patients treated with low-dose rate brachytherapy for localised prostate cancer: results of a single-institution study.
        Radiat Oncol. 2015; 10 (p): 130
        • Thomas C.
        • et al.
        Segmental urethral dosimetry and urinary toxicity in patients with no urinary symptoms before permanent prostate brachytherapy.
        Int J Radiat Oncol Biol Phys. 2008; 72 (p.): 447-455
        • Langley S.E.M.
        • et al.
        Long-term oncological outcomes and toxicity in 597 men aged ≤60 years at time of low-dose-rate brachytherapy for localised prostate cancer.
        BJU Int. 2018; 121 (p.): 38-45
        • Lamb D.S.
        • et al.
        A prospective audit of the 10-year outcomes from low dose-rate brachytherapy for early stage prostate cancer.
        N Z Med J. 2018; 131 (p.): 13-18
        • Stish B.J.
        • et al.
        Low dose rate prostate brachytherapy.
        Trans androl urol. 2018; 7 (p.): 341-356
        • Nakamura S.
        • et al.
        After low and high dose-rate interstitial brachytherapy followed by IMRT radiotherapy for intermediate and high risk prostate cancer.
        BMC Cancer. 2016; 16 (p.): 296
        • Logghe P.
        • et al.
        Long term outcome and side effects in patients receiving low-dose I125 brachytherapy: a retrospective analysis.
        Int braz j urol. 2016; 42 (p.): 906-917
        • Van Gellekom M.P.R.
        • et al.
        Quality of life of patients after permanent prostate brachytherapy in relation to dosimetry.
        Int J Radiat Oncol*Biol*Physic. 2005; 63 (p.): 772-780
        • Mori H.
        • et al.
        Predictive factors for prolonged urination disorder after permanent (125)i brachytherapy for localized prostate cancer.
        In vivo (Athens, Greece),. 2017; 31 (p.): 755-761