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Onishi K, Nakai Y, Maesaka F, Tomizawa M, Shimizu T, Hori S, Gotoh D, Miyake M, Yamaki K, Asakawa I, Isohashi F, Fujimoto K, Tanaka N. Duration of α-1 adrenergic antagonist administration after low-dose-rate brachytherapy for prostate cancer. Jpn J Clin Oncol 2024:hyae113. [PMID: 39193647 DOI: 10.1093/jjco/hyae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 08/16/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Urinary dysfunction is an adverse event of low-dose-rate brachytherapy (LDR-BT) in patients with prostate cancer. We aimed to examine the time to α-1 adrenergic antagonist withdrawal after LDR-BT initiation. METHODS We retrospectively evaluated 1663 patients who underwent LDR-BT at our hospital during 2004-2022. RESULTS Overall, 1485/1663 (89.3%) patients were able to stop using α-1 adrenergic antagonists, 1111 (66.8%) of them within 1 year of LDR-BT. Risk factors for prolonged time to withdrawal were age ≥70 years, taking agents for lower urinary tract symptoms prior to LDR-BT, an International Prostate Symptom Score ≥8, an Overactive Bladder Symptom Score ≥3 and a residual urine volume ≥20 ml. Of the patients who were able to stop taking α-1 adrenergic antagonists, 357/1485 (24.0%) required resumption, 218 (61.1%) of whom did so between 1 and 3 years after LDR-BT. This period matched the period of transient worsening of the urinary symptom score. Finally, multivariable analysis identified supplemental external beam radiotherapy and an Overactive Bladder Symptom Score ≥3 as independent risk factors for α-1 adrenergic antagonist resumption. CONCLUSIONS Withdrawal of α-1 adrenergic antagonists was possible in 66.8% of patients within 1 year of LDR-BT. Our results suggest that patients who are older or have pre-treatment LUTS may have prolonged deterioration of urinary dysfunction after treatment. Resumption of α-1 adrenergic antagonists 1-3 years after treatment may be associated with urinary symptom flares, and close attention is necessary for patients with supplemental external beam radiotherapy and a high pretreatment Overactive Bladder Symptom Score.
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Affiliation(s)
- Kenta Onishi
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Fumisato Maesaka
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Mitsuru Tomizawa
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Takuto Shimizu
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Kaori Yamaki
- Department of Radiation Oncology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Isao Asakawa
- Department of Radiation Oncology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Fumiaki Isohashi
- Department of Radiation Oncology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
- Department of Prostate Brachytherapy, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
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Taniguchi T, Kawase M, Nakane K, Nakano M, Iinuma K, Kato D, Takai M, Tobisawa Y, Mori T, Takano H, Kumano T, Matsuo M, Ito T, Koie T. Prognostic Factors for Resolution Delay of Lower Urinary Tract Symptoms in Patients with Prostate Cancer after Low-Dose-Rate Brachytherapy. Cancers (Basel) 2023; 15:4048. [PMID: 37627078 PMCID: PMC10452417 DOI: 10.3390/cancers15164048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Urinary storage symptoms after low-dose-rate brachytherapy (LDR-BT) with iodine-125 have been noted to be less likely to improve to baseline compared to voiding symptoms. This study aimed to evaluate the chronological changes in the overactive bladder symptom score (OABSS) and the time-to-resolution of OABSS in patients undergoing LDR-BT. Patients with prostate cancer who underwent LDR-BT at Gifu University Hospital were enrolled. The OABSS was evaluated before and after LDR-BT. Patients were divided into the OABSS resolution and resolution delay groups, and the association between OABSS resolution delay and clinicopathological covariates was evaluated. In total, 237 patients were enrolled in this study, with a median follow-up of 88.3 months. The OABSS in both groups worsened at 3 months following operation and gradually recovered at 9 months; however, the OABSS in the resolution delay group tended to worsen again after that. In the multivariate analysis, preoperative OABSS and the change from baseline to maximal OABSS were associated with OABSS resolution. To our knowledge, this is the first study to evaluate the delayed resolution of OABSS after LDR-BT in patients with prostate cancer. A low baseline OABSS and significant changes in the OABSS from baseline were independent predictors of delayed OABSS resolution.
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Affiliation(s)
- Tomoki Taniguchi
- Department of Urology, Ogaki Municipal Hospital, 4-86 Minaminokawacho, Ogaki, Gifu 5038502, Japan;
| | - Makoto Kawase
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (M.K.); (K.N.); (K.I.); (D.K.); (M.T.); (Y.T.)
| | - Keita Nakane
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (M.K.); (K.N.); (K.I.); (D.K.); (M.T.); (Y.T.)
| | - Masahiro Nakano
- Department of Urology, Gifu Prefectural General Medical Center, 4-6-1 Noisiki, Gifu 5008717, Japan;
| | - Koji Iinuma
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (M.K.); (K.N.); (K.I.); (D.K.); (M.T.); (Y.T.)
| | - Daiki Kato
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (M.K.); (K.N.); (K.I.); (D.K.); (M.T.); (Y.T.)
| | - Manabu Takai
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (M.K.); (K.N.); (K.I.); (D.K.); (M.T.); (Y.T.)
| | - Yuki Tobisawa
- Department of Urology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (M.K.); (K.N.); (K.I.); (D.K.); (M.T.); (Y.T.)
| | - Takayuki Mori
- Department of Radiology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (T.M.); (H.T.); (T.K.); (M.M.)
| | - Hirota Takano
- Department of Radiology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (T.M.); (H.T.); (T.K.); (M.M.)
| | - Tomoyasu Kumano
- Department of Radiology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (T.M.); (H.T.); (T.K.); (M.M.)
| | - Masayuki Matsuo
- Department of Radiology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan; (T.M.); (H.T.); (T.K.); (M.M.)
| | - Takayasu Ito
- Center for Clinical Training and Career Development, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 5011194, Japan;
| | - Takuya Koie
- Department of Urology, Ogaki Municipal Hospital, 4-86 Minaminokawacho, Ogaki, Gifu 5038502, Japan;
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Tsuchiya K, Kawase M, Nakane K, Nakano M, Iinuma K, Kato D, Takai M, Tobisawa Y, Mori T, Takano H, Kumano T, Matsuo M, Ito T, Koie T. Chronological Changes of Lower Urinary Tract Symptoms in Elderly Patients with Prostate Cancer after Low-Dose-Rate Prostate Brachytherapy. Life (Basel) 2023; 13:1507. [PMID: 37511882 PMCID: PMC10381757 DOI: 10.3390/life13071507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND To compare chronological changes in lower urinary tract symptoms (LUTS) after low-dose-rate prostate extended-release therapy (LDR-BT) using the overactive bladder symptom score (OABSS) in patients aged ≥ 75 years (elderly group) versus those aged < 75 years (control group). MATERIALS AND METHODS Patients with prostate cancer who underwent LDR-BT at Gifu University Hospital were included in this study. The International Prostate Symptom Score (IPSS), OABSS, and quality of life-based on urinary symptoms (IPSS-QOL) were evaluated before and after LDR-BT. We compared chronological changes in IPSS, OABSS, and IPSS-QOL in the elderly group with those in the control group and assessed the association between the resolution of OABSS and clinicopathological covariates. RESULTS A total of 484 patients were enrolled in this study. In the elderly group, the total IPSS, OABSS, and frequency scores increased at 1 month postoperatively, whereas the control group showed an increase at 3 months postoperatively. Multivariate analysis identified changes from baseline to the maximum OABSS and pre-treatment OABSS as significant predictors of delayed resolution of OABSS after LDR-BT. CONCLUSIONS Changes in pre-treatment OABSS and pre- and post-LDR-BT OABSS values were independent predictors of delayed resolution of OABSS; however, no correlation was found with age.
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Affiliation(s)
- Kunihiro Tsuchiya
- Department of Urology, General Home Care Clinic, Gifu 5016014, Japan
| | - Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Masahiro Nakano
- Department of Urology, Gifu Prefectural General Medical Center, Gifu 5008717, Japan
| | - Koji Iinuma
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Daiki Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Manabu Takai
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Yuki Tobisawa
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Takayuki Mori
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Hirota Takano
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Tomoyasu Kumano
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Takayasu Ito
- Center for Clinical Training and Career Development, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
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Ito M, Makita C, Mori T, Takano H, Kumano T, Matsuo M, Iinuma K, Kawase M, Nakane K, Nakano M, Koie T. Associations of Clinical and Dosimetric Parameters with Urinary Toxicities after Prostate Brachytherapy: A Long-Term Single-Institution Experience. Curr Oncol 2023; 30:5680-5689. [PMID: 37366909 DOI: 10.3390/curroncol30060426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
To examine the association of clinical, treatment, and dose parameters with late urinary toxicity after low-dose-rate brachytherapy (LDR-BT) for prostate cancer, we retrospectively studied patients with prostate cancer who underwent LDR-BT from January 2007 through December 2016. Urinary toxicity was assessed using the International Prostate Symptom Score (IPSS) and Overactive Bladder (OAB) Symptom Score (OABSS). Severe and moderate lower urinary tract symptoms (LUTS) were defined as IPSS ≥ 20 and ≥ 8, respectively; OAB was defined as a nocturnal frequency of ≥ 2 and a total OABSS of ≥ 3. In total, 203 patients (median age: 66 years) were included, with a mean follow-up of 8.4 years after treatment. The IPSS and OABSS worsened after 3 months of treatment; these scores improved to pretreatment levels after 18-36 months in most patients. Patients with a higher baseline IPSS and OABSS had a higher frequency of moderate and severe LUTS and OAB at 24 and 60 months, respectively. LUTS and OAB at 24 and 60 months were not correlated with the dosimetric factors of LDR-BT. Although the rate of long-term urinary toxicities assessed using IPSS and OABSS was low, the baseline scores were related to long-term function. Refining patient selection may further reduce long-term urinary toxicity.
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Affiliation(s)
- Masaya Ito
- Department of Radiation Oncology, Gifu Takayama Red Cross Hospital, 3-11, Tenmancho, Takayama City 500-8717, Gifu, Japan
- Department of Radiology, Gifu University Hospital, 1-1, Yanagido, Gifu City 500-1194, Gifu, Japan
| | - Chiyoko Makita
- Department of Radiology, Gifu University Hospital, 1-1, Yanagido, Gifu City 500-1194, Gifu, Japan
| | - Takayuki Mori
- Department of Radiology, Gifu University Hospital, 1-1, Yanagido, Gifu City 500-1194, Gifu, Japan
| | - Hirota Takano
- Department of Radiology, Gifu University Hospital, 1-1, Yanagido, Gifu City 500-1194, Gifu, Japan
| | - Tomoyasu Kumano
- Department of Radiology, Gifu University Hospital, 1-1, Yanagido, Gifu City 500-1194, Gifu, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University Hospital, 1-1, Yanagido, Gifu City 500-1194, Gifu, Japan
| | - Koji Iinuma
- Department of Urology, Gifu University Hospital, 1-1, Yanagido, Gifu City 500-1194, Gifu, Japan
| | - Makoto Kawase
- Department of Urology, Gifu University Hospital, 1-1, Yanagido, Gifu City 500-1194, Gifu, Japan
| | - Keita Nakane
- Department of Urology, Gifu University Hospital, 1-1, Yanagido, Gifu City 500-1194, Gifu, Japan
| | - Masahiro Nakano
- Department of Urology, Gifu Prefectural General Medical Center, 4-6-1, Noisshiki, Gifu City 500-8717, Gifu, Japan
| | - Takuya Koie
- Department of Urology, Gifu University Hospital, 1-1, Yanagido, Gifu City 500-1194, Gifu, Japan
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Ogasawara N, Nakiri M, Kurose H, Ueda K, Chikui K, Nishihara K, Matsuo M, Suekane S, Morimatsu Y, Murotani K, Muraki K, Hattori C, Ogo E, Ishitake T, Igawa T. Sarcopenia and excess visceral fat accumulation negatively affect early urinary function after I‐125 low‐dose‐rate brachytherapy for localized prostate cancer. Int J Urol 2022; 30:347-355. [PMID: 36520921 DOI: 10.1111/iju.15120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To evaluate the effects of sarcopenia and excess visceral fat accumulation on early urinary function after I-125 low-dose-rate brachytherapy for prostate cancer. METHODS We retrospectively reviewed consecutive patients who underwent brachytherapy for prostate cancer. Pre-treatment computed tomography was used to measure skeletal muscle index at the L3 level to assess sarcopenia and visceral fat area at the umbilical level. The International Prostate Symptom Score and the University of California Los Angeles Prostate Cancer Index were used to assess quality of life during the 24 months after brachytherapy. Logistic regression analysis was used to examine whether sarcopenia and excess visceral fat accumulation had clinically significant effects on post-treatment quality of life. RESULTS Among 246 patients, 92 (37.4%) were stratified into the sarcopenia group and 141 (57.3%) into the excess visceral fat accumulation group. The sarcopenia group had significantly lower University of California Los Angeles Prostate Cancer Index urinary function than the non-sarcopenia group 24 months post-brachytherapy. The excess visceral fat accumulation group had significantly poorer International Prostate Symptom Score total, storage, and voiding scores than the non-excess accumulation group 12 months post-brachytherapy. In the multivariate analysis, sarcopenia had a clinically significant adverse effect on the University of California Los Angeles Prostate Cancer Index urinary function at 12 months. Excess visceral fat accumulation had a clinically significant adverse effect on the International Prostate Symptom Score voiding and storage scores at 12 months. CONCLUSIONS Sarcopenia and excess visceral fat accumulation negatively affect urinary function early after I-125 low-dose-rate brachytherapy for prostate cancer.
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Affiliation(s)
- Naoyuki Ogasawara
- Department of Urology Kurume University School of Medicine Kurume Japan
- Department of Environmental Medicine Kurume University School of Medicine Kurume Japan
| | - Makoto Nakiri
- Department of Urology Kurume University School of Medicine Kurume Japan
| | - Hirofumi Kurose
- Department of Urology Kurume University School of Medicine Kurume Japan
| | - Kosuke Ueda
- Department of Urology Kurume University School of Medicine Kurume Japan
| | - Katsuaki Chikui
- Department of Urology Kurume University School of Medicine Kurume Japan
| | - Kiyoaki Nishihara
- Department of Urology Kurume University School of Medicine Kurume Japan
| | - Mitsunori Matsuo
- Department of Urology Kurume University School of Medicine Kurume Japan
| | - Shigetaka Suekane
- Department of Urology Kurume University School of Medicine Kurume Japan
| | - Yoshitaka Morimatsu
- Department of Environmental Medicine Kurume University School of Medicine Kurume Japan
| | - Kenta Murotani
- Biostatistics Center Kurume University School of Medicine Kurume Japan
| | - Koichiro Muraki
- Department of Radiology Kurume University School of Medicine Kurume Japan
| | - Chikayuki Hattori
- Department of Radiology Kurume University School of Medicine Kurume Japan
| | - Etsuyo Ogo
- Department of Radiology Kurume University School of Medicine Kurume Japan
| | - Tatsuya Ishitake
- Department of Environmental Medicine Kurume University School of Medicine Kurume Japan
| | - Tsukasa Igawa
- Department of Urology Kurume University School of Medicine Kurume Japan
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Assessment of Long-term Changes in Lower Urinary Tract Symptoms in Patients With Prostate Cancer Who Underwent Low-dose-rate Prostate Brachytherapy. Urology 2020; 142:213-220. [PMID: 32416115 DOI: 10.1016/j.urology.2020.04.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate long-term changes in lower urinary tract symptoms in patients with prostate cancer (PCa) who underwent low-dose-rate brachytherapy with iodine-125 (LDR-BT). PATIENTS AND METHODS In this retrospective study, 313 patients with localized PCa underwent LDR-BT at Gifu University hospital between August 2004 and December 2013. The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and quality of life due to urinary symptoms (IPSS-QOL) were measured before LDR-BT; at 1, 3, 6, 9, 12, 24, 36, 48, and 60 months after LDR-BT; and annually thereafter. Study endpoints were chronological changes in IPSS, OABSS, and IPSS-QOL compared to pretreatment values. A multivariable nonlinear regression model with robust sandwich estimator evaluated association between outcomes and time with adjustment for covariates. RESULTS All scores worsened immediately after LDR-BT compared to preoperative scores. However, symptoms improved with time and returned to baseline in 18-36 months. After a 5-year follow-up after LDR-BT, OABSS significantly worsened in almost all patients compared to baseline although there were gradual improvements in less than 5 years after LDR-BT. CONCLUSIONS Our results may be of clinical importance in selecting treatment modalities for patients with localized PCa and long-term survival after definitive therapy.
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A Review of Permanent Prostate Brachytherapy as Practiced in Japan. Brachytherapy 2019. [DOI: 10.1007/978-981-13-0490-3_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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