Clinical predictors of acute urinary symptoms after prostate radiotherapy

The severity of acute urinary symptoms in patients who underwent radiotherapy for early prostate cancer can be predicted by using a modeling program together with the International Prostate Symptom Score (IPSS) and dosage measure. These findings from an ad-interim analysis were presented at the 5th European Multidisciplinary Meeting on Urological Cancers, which was held in Marseille, France, on November 15-17, 2013.

"Quantitative models predicting the risk of acute (and late) genitourinary toxicity in patients treated with high-dose radiotherapy for prostate cancer are lacking. This work represents one of the first attempts to provide radiation oncologists with quantitative tools to reliably predict the risk of moderate-severe acute GU effects based on both clinical and dosimetric individual parameters," said Dr. Cesare Cozzarini of the San Raffaele Scientific Institute in Milan, Italy.

Cozzarini and colleagues started a prospective cohort study, known as DUE-01, in April 2010. It aimed to develop predictive models of genitourinary toxicity and erectile dysfunction after high dose radiotherapy for prostate cancer. The study included patients treated with conventional (1.8-2 Gy/fr) or moderate hypo-fractionation (2.5-2.7 Gy/fr).

At the time of the analysis in January 2013, 339 patients from nine institutes have been enrolled in the study. Clinical data for 212 of the 339 patients were available, with 93 having received the conventional radiotherapy and 119 having received moderate hypofractionation. Data on IPSS was collected at both baseline and at the end of radiotherapy for 172 of the 212 patients.

The number of patients with IPSS scores of 4 or more increased from 8 to 30 for pollakiuria, from 5 to 20 for dysuria, and from 12 to 34 for nicturia.

"This study, DUE-01, is aimed at prospectively collecting an enormous number of patient-reported information concerning genitourinary toxicity and erectile dysfunction before, during, and at the end of radiotherapy and for a period of 4 years after its completion," said Cozzarini.

"The study therefore has a high probability of helping to develop highly reliable models for the prediction of acute and late genitourinary toxicity and erectile dysfunction and their impact on quality of life," he added. He stated that the final results of this investigation should significantly impact the evolution of radiotherapy of prostate cancer in the next 5 to 10 years. He feels that this evolution will lead to a more refined "tailoring" of the radiation therapy, and that will result in a significant reduction of genitourinary toxicity and sexual dysfunction.

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