"The results offer physicians some simple and inexpensive pretreatment testing that helps identify patients who would be at increased risk for developing urinary complications," says Michael Wehle, M.D., of the Mayo Clinic Department of Urology, and the primary author of the study.
Of the 105 men studied at Mayo Clinic in Jacksonville, Fla., 59 (56 percent) were categorized by researchers as being in the high-risk category and 46 (44 percent) were categorized as low risk for urinary tract difficulties after the therapy. Using this criteria, 37 percent of the high-risk patients developed some urinary difficulties. Eighty-five percent of the low-risk patients did not have difficulties after the therapy.
Researchers expect men with these problems to have a greater risk of experiencing urinary problems after the procedure.
The purpose of the study was to better define who is and who isn't a good candidate for brachytherapy. Brachytherapy involves placing radioactive seeds in or near the tumor, to deliver a high dose of radiation to the tumor while reducing the radiation exposure in the surrounding healthy tissues. This may be done surgically or through other means, such as using a needle. Researchers studied records of patients who received radioactive seeds implanted for prostate cancer.
"In general, most brachytherapy patients do very well, but a few can have significant problems," said Dr. Wehle.
Difficulties can include urine retention, the need to use a catheter to urinate, frequent urination and pain when urinating. Researchers assessed conditions such as severity of symptoms, urinary flow rate, residual urinary volume and prostate volume. Using these assessments, physicians can better select patients and offer them educational counseling to avoid serious complications after brachytherapy.
Others involved in the study were: Scott Lisson, M.D., Gregory Broderick, M.D., Paul Young, M.D. and Todd Igel, M.D., of the Mayo Clinic Department of Urology, and Steven Buskirk, M.D., of the Mayo Clinic Department of Radiation Oncology.
In an editorial in the same issue, Igor Frank, M.D., and Michael Blute, M.D., of Mayo ClinicÕs Department of Urology say this study provides an important step in helping physicians inform patients about the risk of severe urinary difficulties associated with brachytherapy.
"As the number of treatment options expands, the need for evidence-based stratification tools increases," they write. "Such data-based tools would enable the clinician and patient to identify treatment choices associated with the least morbidity, without altering rates of disease control, on the basis of the patient's individual anatomical and physiological characteristics." Once these tools are established, patients can be directed toward therapies that are least likely to negatively affect their quality of life.
A peer-reviewed journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research, and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation as part of its commitment to the medical education of physicians. The journal has been published for more than 75 years and has a circulation of 130,000 nationally and internationally.
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