Delayed hematuria common after prostate brachytherapy

By Sally Robertson, B.Sc.Feb 4 2013

A significant proportion of patients with prostate cancer who are treated with brachytherapy develop gross hematuria years later, report researchers.

Those most at risk for the condition are patients with larger prostates, those who have additional treatment with external beam radiation, and those who have biochemical prostate-specific antigen (PSA) control after treatment, says the team.

The findings come from a study of 20-year data collected for 2454 men, aged a mean of 67 years, who received transperineal permanent prostate interstitial brachytherapy.

Led by Michael Leapman (Mount Sinai School of Medicine, New York, USA), the team found that 218 (8.9%) of the men developed hematuria, over a mean period of 5.9 years, with 628 individual hematuria events identified.

Six months after treatment, only 20 (3.2%) of the patients reported hematuria, whereas after 72 months, 100 (15.9%) individuals reported the condition.

"Many men reported initial or sustained hematuria occurring several years after implantation," say the researchers. "This may be the result of several factors, including the protracted contribution of radiation-altered prostatic and bladder tissue with accumulated physiological causes of hematuria seen with aging and prostatic growth that may require years to develop."

As noted in BJU International, a significantly smaller proportion of the 1417 patients with a pre-treatment prostate volume of less than 40 cm³ reported hematuria than of the 1022 men with larger prostates, at 103 (7.2%) versus 114 (11.1%).

The researchers also found that a significantly lower proportion of the 234 patients who met Phoenix criteria for biochemical failure reported hematuria than of the 2220 who did not, at 3.8% versus 9.4%.

"One explanation for this finding may be that patients who are more sensitive to radiation may be more likely to receive a favorable treatment response, but also experience increased mucosal injury or necrosis leading to hematuria," they write.

In addition, a greater proportion of patients who received brachytherapy in combination with external beam radiation reported hematuria than did of patients who received the implant alone, at 11.7% versus 7.3%.

Regression analysis showed that prostate volume, biochemical control, and external beam radiation were all significant predictors for hematuria in the population.

"Gross hematuria after prostate brachytherapy is a vexing clinical scenario that may be observed several years after treatment," write Leapman et al.

"The significance of observed blood in urine after permanent brachytherapy remains unclear and warrants further study to understand the etiology and clinical course of this morbidity," they conclude.

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