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Androgen deprivation-induced changes in prostate anatomy predict urinary morbidity after permanent interstitial brachytherapy.
Int J Radiat Oncol Biol Phys 2004; 59(5):1367-82IJ

Abstract

PURPOSE

To evaluate the cytoreductive consequences of neoadjuvant androgen deprivation therapy on International Prostate Symptom Score (IPSS) normalization, catheter dependency, and the need for surgical intervention secondary to bladder outlet obstruction after permanent interstitial brachytherapy.

METHODS AND MATERIALS

A total of 116 patients (median follow-up, 30 months) with preandrogen and postandrogen deprivation therapy ultrasound studies and no history of preimplant transurethral resection of the prostate were evaluated. Androgen deprivation-induced changes in prostate volume, transition zone (TZ) volume, and urethral location were correlated with IPSS resolution, catheter dependency, and the need for postimplant surgical intervention. Prostate gland and TZ dimensions and volumes were measured by prolate ellipsoid calculation from the static ultrasound images. The urethral location was determined by identification of a urinary catheter. Additional clinical, treatment, and dosimetric parameters evaluated included patient age, pretreatment prostate-specific antigen, Gleason score, clinical T stage, preimplant IPSS, pre- and postandrogen deprivation ultrasound studies, treatment planning volume, supplemental external beam RT, isotope, total implant activity, Day 0 maximal dose received by 90% of the prostate gland, Day 0 percentage of prostate volume receiving 100%, 150%, and 200% of the prescribed minimal peripheral dose, and urethral dose.

RESULTS

For hormonally manipulated patients, the prostate volume at implantation did not have a statistical influence on the percentage of patients returning to IPSS baseline, the time for IPSS normalization, the incidence of catheter dependency, the catheter-dependency time, or the need for postimplant surgical intervention. However, when compared with the hormone-naive cohort, hormonally manipulated patients were more likely to undergo postimplant surgical intervention (5.2% vs. 0.3%, p = 0.001). Greater androgen deprivation-induced reductions in prostate and TZ volumes, along with movement of the urethra closer to the posterior border of the prostate gland, resulted in a decreased incidence of postimplant urinary morbidity. Using Cox regression analysis, the time to IPSS resolution was best predicted by the percentage of TZ volume reduction. Stepwise linear regression analysis demonstrated that the catheter-dependency time was best predicted by the prehormonal therapy prostate volume, posthormonal therapy TZ volume, and the change in the urethral position; prolonged catheter dependency by the percentage of TZ volume reduction, prehormonal therapy TZ index, and the change in the urethral position; and the need for postimplant surgical intervention by the posthormonal therapy TZ index and the change in the urethral location.

CONCLUSION

After neoadjuvant androgen deprivation therapy for volume reduction, some brachytherapy-related urinary morbidity parameters are highly related to the preandrogen deprivation prostate volume, variants in the TZ volume, and changes in the urethral location.

Authors+Show Affiliations

Schiffler Cancer Center, Wheeling Hospital, 1 Medical Park, Wheeling, WV 26003-6300, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15275722

Citation

Hinerman-Mulroy, Ashley, et al. "Androgen Deprivation-induced Changes in Prostate Anatomy Predict Urinary Morbidity After Permanent Interstitial Brachytherapy." International Journal of Radiation Oncology, Biology, Physics, vol. 59, no. 5, 2004, pp. 1367-82.
Hinerman-Mulroy A, Merrick GS, Butler WM, et al. Androgen deprivation-induced changes in prostate anatomy predict urinary morbidity after permanent interstitial brachytherapy. Int J Radiat Oncol Biol Phys. 2004;59(5):1367-82.
Hinerman-Mulroy, A., Merrick, G. S., Butler, W. M., Wallner, K. E., Allen, Z., & Adamovich, E. (2004). Androgen deprivation-induced changes in prostate anatomy predict urinary morbidity after permanent interstitial brachytherapy. International Journal of Radiation Oncology, Biology, Physics, 59(5), pp. 1367-82.
Hinerman-Mulroy A, et al. Androgen Deprivation-induced Changes in Prostate Anatomy Predict Urinary Morbidity After Permanent Interstitial Brachytherapy. Int J Radiat Oncol Biol Phys. 2004 Aug 1;59(5):1367-82. PubMed PMID: 15275722.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Androgen deprivation-induced changes in prostate anatomy predict urinary morbidity after permanent interstitial brachytherapy. AU - Hinerman-Mulroy,Ashley, AU - Merrick,Gregory S, AU - Butler,Wayne M, AU - Wallner,Kent E, AU - Allen,Zachariah, AU - Adamovich,Edward, PY - 2003/11/03/received PY - 2004/01/13/revised PY - 2004/01/16/accepted PY - 2004/7/28/pubmed PY - 2004/8/31/medline PY - 2004/7/28/entrez SP - 1367 EP - 82 JF - International journal of radiation oncology, biology, physics JO - Int. J. Radiat. Oncol. Biol. Phys. VL - 59 IS - 5 N2 - PURPOSE: To evaluate the cytoreductive consequences of neoadjuvant androgen deprivation therapy on International Prostate Symptom Score (IPSS) normalization, catheter dependency, and the need for surgical intervention secondary to bladder outlet obstruction after permanent interstitial brachytherapy. METHODS AND MATERIALS: A total of 116 patients (median follow-up, 30 months) with preandrogen and postandrogen deprivation therapy ultrasound studies and no history of preimplant transurethral resection of the prostate were evaluated. Androgen deprivation-induced changes in prostate volume, transition zone (TZ) volume, and urethral location were correlated with IPSS resolution, catheter dependency, and the need for postimplant surgical intervention. Prostate gland and TZ dimensions and volumes were measured by prolate ellipsoid calculation from the static ultrasound images. The urethral location was determined by identification of a urinary catheter. Additional clinical, treatment, and dosimetric parameters evaluated included patient age, pretreatment prostate-specific antigen, Gleason score, clinical T stage, preimplant IPSS, pre- and postandrogen deprivation ultrasound studies, treatment planning volume, supplemental external beam RT, isotope, total implant activity, Day 0 maximal dose received by 90% of the prostate gland, Day 0 percentage of prostate volume receiving 100%, 150%, and 200% of the prescribed minimal peripheral dose, and urethral dose. RESULTS: For hormonally manipulated patients, the prostate volume at implantation did not have a statistical influence on the percentage of patients returning to IPSS baseline, the time for IPSS normalization, the incidence of catheter dependency, the catheter-dependency time, or the need for postimplant surgical intervention. However, when compared with the hormone-naive cohort, hormonally manipulated patients were more likely to undergo postimplant surgical intervention (5.2% vs. 0.3%, p = 0.001). Greater androgen deprivation-induced reductions in prostate and TZ volumes, along with movement of the urethra closer to the posterior border of the prostate gland, resulted in a decreased incidence of postimplant urinary morbidity. Using Cox regression analysis, the time to IPSS resolution was best predicted by the percentage of TZ volume reduction. Stepwise linear regression analysis demonstrated that the catheter-dependency time was best predicted by the prehormonal therapy prostate volume, posthormonal therapy TZ volume, and the change in the urethral position; prolonged catheter dependency by the percentage of TZ volume reduction, prehormonal therapy TZ index, and the change in the urethral position; and the need for postimplant surgical intervention by the posthormonal therapy TZ index and the change in the urethral location. CONCLUSION: After neoadjuvant androgen deprivation therapy for volume reduction, some brachytherapy-related urinary morbidity parameters are highly related to the preandrogen deprivation prostate volume, variants in the TZ volume, and changes in the urethral location. SN - 0360-3016 UR - https://www.unboundmedicine.com/medline/citation/15275722/Androgen_deprivation_induced_changes_in_prostate_anatomy_predict_urinary_morbidity_after_permanent_interstitial_brachytherapy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0360301604001191 DB - PRIME DP - Unbound Medicine ER -