2409 - Clinical Factors Associated with Urinary Morbidity in Men Undergoing Combination Prostate Radiation Therapy
Presenter(s)
B. Lee1, R. Lee1, J. Benton2, and A. Dewar2; 1Urology of Greater Atlanta, Stockbridge, GA, 2Radiotherapy Clinics of Georgia, Decatur, GA
Purpose/Objective(s): The purpose of our investigation was to determine if pre-treatment factors could predict urinary morbidity after combination brachytherapy and external beam radiation treatment for localized prostate cancer.
Materials/Methods: A retrospective study of a large single-institution historical database was performed. Medical records of 278 consecutive patients who were treated starting May 2012 with prostate I-125 seed implant followed by intensity-modulated radiation therapy (IMRT) were analyzed. We investigated whether the following pre-existing comorbidities or factors were predictive for urinary morbidity: hypertension (HTN), diabetes (DM), smoking status, patient age, severity of pre-existing urinary symptoms, presence of prostate nodule, pre-procedure hormonal ablative therapy, confidence in erectile function, race, pre-procedure PSA, Gleason Score, use of alpha-blocker medications, and Body Mass Index (BMI). Urinary morbidity was defined as at least a 25% increase from baseline in the International Prostate Symptom Score (IPSS) at the 6-month and 12-month follow-up visit.
Results: A total of 243 patients had complete data for inclusion at the 6-month interval and 180 patients had both 6 and 12-month data. Gleason score was 7 or higher in 173 patients. Baseline IPSS was mild (0-7) in 148 patients, moderate (8-19) in 78 patients, and severe (20-35) in 16 patients. The results are summarized in the chart below. At 6-months, strong predictive factors were the presence of pre-existing urinary morbidity (based on IPSS) and the pre-treatment use of alpha-blocker medications. Logistic regression analysis demonstrated higher risk for younger age. At 12-months, only the IPSS was predictive. The following combinations of factors were also evaluated: 1. HTN and DM, 2. HTN, DM, and Age, and 3. HTN, DM, Age, and BMI. Logistic regression analysis did not demonstrate an increased risk.
Conclusion: Pre-existing urinary symptoms were strongly predictive for urinary morbidity at 6-months and 12-months post-procedure while the other multitude of factors were not. Combining pre-procedure comorbidities did not increase risk.
Abstract 2409 - Table 1| Variable | Categories | p-value (6 months) | Chi-Squared test/Logistic Regression | p-value (12 months) | Chi-Squared test/Logistic Regression |
| Hypertension | (Yes, No) | 0.2293 | Not significant | 0.9309 | Not significant |
| Diabetes | (Yes, No) | 0.3584 | Not significant | 0.8188 | Not significant |
| Smoking | (Yes, No) | 0.6014 | Not significant | 0.2709 | Not significant |
| Pre-Tx AUA Total | (Mild 0-7, Moderate 8-19, Severe 20 - 35) | <.001 | significant | <.001 | significant |
| Race | (Black, White) | 0.8100 | Not significant | 0.2879 | Not significant |
| PSA (Pre-Treatment) | (Below 6, 6+) | 0.6714 | Not significant | 0.6256 | Not significant |
| Gleason Score | (Low 6, Moderate (3+4, 4+3), High 8+) | 0.6065 | Not significant | 0.1760 | Not significant |
| Alpha Blocker Medication | (Yes, No) | 0.0157 | significant | 0.2092 | Not significant |
| BMI | (Obese, Not Obese) 30+ | 0.5165 | Not significant | 0.8092 | Not significant |