Factors associated with the frequency of self-intermittent catheterization after prostate brachytherapy

Abstract 

Purpose

Urinary obstructive symptoms are the most common side effects of transperineal interstitial permanent prostate brachytherapy (TIPPB). Self-intermittent catheterization (SIC) can be used to relieve urinary retention. This study evaluated the factors associated with the probability of a patient performing SIC after TIPPB.

Methods and materials

We prospectively evaluated 204 patients who underwent TIPPB at Mayo Clinic Scottsdale (MCS). All patients were taught to perform SIC before implant and were instructed to do so if they could not urinate at any time after the procedure.

Results

Of the 204 patients, 22 patients (11%) received ¹⁰³Pd seeds and 182 patients (89%) received ¹²⁵I. Thirty-seven (18%) patients received external-beam radiotherapy (XRT) in addition to the TIPPB. SIC was performed by 69 (34%) of the 204 patients. Factors that were significantly associated with a lower frequency of SIC were prostate volumes ≤34.2 cm³ (p = 0.005), ≤137 seeds implanted (p = 0.04), prostate-specific antigen (PSA) levels ≤6.35 (p = 0.03), American Urological Association (AUA) score ≤10 (p = 0.01), the use of ¹²⁵I (p = 0.03), and the addition of XRT to the implant (p = 0.02).

Conclusions

Significant associations were observed between the frequency of SIC and the number of seeds implanted, AUA scores, prostate volume, PSA levels, addition of XRT, and isotope used. Whereas the first four of these factors may be surrogates for prostate volume and obstructive symptoms in general, the last two factors are related to treatment decisions. These findings may aid in better patient selection and therapeutic decisions. Additionally, this information may provide a clearer understanding of the urinary side effects of TIBBP.

Keywords:  Prostate cancer, Brachytherapy, Self-intermittent catheterization