Permanent prostate brachytherapy is safe in men with severe baseline lower urinary tract symptoms

Purpose: To evaluate the long-term urinary outcomes of men with severe pretreatment lower urinary tract symptoms (LUTS)treated with permanent prostate brachytherapy (PPB)± external beam radiation therapy for localized prostate cancer. Methods and materials: A total of 105 men with International Prostate Symptom Score (IPSS)20–35 before PPB were categorized by IPSS change at last followup: (1)worse = IPSS rise >3; (2)no change = IPSS change within three points of baseline; (3)improved = IPSS fall by >3 points. We then evaluated patients who worsened vs. those who did not (no change or improved)with respect to incontinence outcomes, LUTS medication usage, and predictors of symptom worsening. Results: Mean followup was 80.3 ± 55.8 months. Mean age was 66.3 ± 7.1 years; mean pretreatment IPSS was 23.6 ± 3.0. Overall mean improvement in IPSS was 7.6 ± 9.3. Specifically, 14.3% (15/105)worsened, 21.9% (23/105)had no significant change, and 63.8% (67/105)improved. There were no patient- or treatment-related factors significantly associated with long-term worsening of urinary symptoms. No men required anticholinergic therapy at last followup, whereas 7% (8/105)were using an alpha blocker. Only 2.9% (3/105)of men were using at least one pad daily at last followup. Alternatively, only 7.7% (8/105)reported subjective incontinence. Conclusions: PPB is an acceptable option in the setting of severe baseline LUTS in appropriately selected and counseled patients when performed by a skilled practitioner.