Incidence of genitourinary complications following radiation therapy for localised prostate cancer

Abstract

Purpose Studies of genitourinary toxicity following radiotherapy for prostate cancer are mainly from high volume single institutions and the incidence and burden of treatment remain uncertain. Hence we determine the cumulative incidence of treatment-related genitourinary toxicity in patients with localised prostate cancer treated with primary external beam radiotherapy (EBRT) at a state population level. Methods We analysed data from a prospective population-based cohort, including hospital admission and cancer registry data, for men with localised prostate cancer who underwent primary EBRT without nodal irradiation between 1998 and 2019 in South Australia. The 10-year cumulative incidence of genitourinary toxicity requiring hospitalisation or procedures was determined. Clinical predictors of toxicity and the volume of admissions, non-operative, minor operative and major operative procedures were determined. Results All the included patients (n = 3350) had EBRT, with a median (IQR) of 74 Gy (70–78) in 37 fractions (35–39). The 10-year cumulative incidence of was 28.4% (95% CI 26.3–30.6) with a total of 2545 hospital admissions, including 1040 (41%) emergency and 1893 (74%) readmissions. The 10-year cumulative incidence of patients in this cohort requiring a urological operative procedure was 18% (95% CI 16.1–19.9), with a total of 106 (4.2%) non-operative, 1044 (41%) minor operative and 57 (2.2%) major operative urological procedures. Conclusions Genitourinary toxicity after radiotherapy for prostate cancer is common. Although there continue to be advancements in radiotherapy techniques, patients and physicians should be aware of the risk of late toxicity when considering EBRT.

Predicting post-radiation genitourinary hospital admissions in patients with localised prostate cancer

“…However, the majority of included patients were treated with EBRT ≥ 2009 (62%), indicating mostly contemporary treatment techniques. Furthermore, the included clinical predictive factors remained significant in multivariable analysis adjusted for year of treatment, as demonstrated in our recently published article [29]. In addition, we do not have information regarding baseline IPSS, prostate volume or 5-ARI or alpha-blocker medication use before EBRT.…”

Radiation injury and gut microbiota-based treatment

“…Radiation-induced cystitis (RC) is a late-onset and under-reported condition after pelvic radiotherapy with an incidence rate of 5%–10%, even higher ( David et al . 2022 ).…”

Complications after Prostate Cancer Treatment: Pathophysiology and Repair of Post-Radiation Urethral Stricture Disease

“…Studies that tracked urinary AE revealed that about 4% of patients experienced severe AE [ 7 ]. When examining patients diagnosed with prostate cancer who solely received EBRT, a study performed by David et al revealed a 28.4% 10-year cumulative incidence rate of hospital admissions due to urinary AE [ 8 ]. The absence of studies presents a potential future area of exploration and collaboration among diverse disciplines and specialties.…”