Brachytherapy · 2026
Urethral dosimetry and urinary symptoms after prostate brachytherapy: Analyzing key predictive factors.
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Djemhi Sabrina, Benhacene Boudam Mustafa Karim, Nicolas Benedicte, Nadeau Dominic, Delouya Guila, Taussky Daniel
Аннотация
BACKGROUND: Urinary toxicity is a common side effect of prostate brachytherapy. This study evaluated the relationship between urethral dosimetry and urinary symptoms following low-dose prostate brachytherapy.
METHODS: We retrospectively analyzed 175 patients who underwent I-125 prostate brachytherapy. Urethral contours were generated using MRI-TRUS fusion and transferred to day-30 CT scans. Dosimetric parameters were calculated for both rigid and deformed urethral models. Urinary symptoms were assessed using the International Prostate Symptom Score (IPSS) at baseline and 1 month after treatment. Correlations between dosimetric parameters and IPSS were analyzed.
RESULTS: Median IPSS increased from 4 at baseline to 9 at 1 month. Weak correlations were observed between 1-month IPSS and urethral volume, length, and V150 (volume receiving ≥150% of the prescribed dose). Patients with urethral V150 ≥0.61cc had significantly higher 1-month IPSS (mean difference 2.8 points, p = 0.001). In multivariate analysis, only baseline IPSS (p < 0.001) and prostate volume (p = 0.021) independently predicted 1-month IPSS. No dosimetric parameters predicted acute urinary retention.
CONCLUSIONS: Early urinary toxicity after prostate brachytherapy is multifactorial. Baseline urinary function and prostate volume were the strongest predictors, but maintaining low urethral V150 remains important to limit morbidity.
METHODS: We retrospectively analyzed 175 patients who underwent I-125 prostate brachytherapy. Urethral contours were generated using MRI-TRUS fusion and transferred to day-30 CT scans. Dosimetric parameters were calculated for both rigid and deformed urethral models. Urinary symptoms were assessed using the International Prostate Symptom Score (IPSS) at baseline and 1 month after treatment. Correlations between dosimetric parameters and IPSS were analyzed.
RESULTS: Median IPSS increased from 4 at baseline to 9 at 1 month. Weak correlations were observed between 1-month IPSS and urethral volume, length, and V150 (volume receiving ≥150% of the prescribed dose). Patients with urethral V150 ≥0.61cc had significantly higher 1-month IPSS (mean difference 2.8 points, p = 0.001). In multivariate analysis, only baseline IPSS (p < 0.001) and prostate volume (p = 0.021) independently predicted 1-month IPSS. No dosimetric parameters predicted acute urinary retention.
CONCLUSIONS: Early urinary toxicity after prostate brachytherapy is multifactorial. Baseline urinary function and prostate volume were the strongest predictors, but maintaining low urethral V150 remains important to limit morbidity.