Is Hormone Therapy a Protective Factor for Late Hematuria After High-Dose Radiotherapy in Prostate Cancer?
Received 23 November 2007; accepted 21 January 2008. published online 08 April 2008.
Objectives
To identify potential clinical and dosimetric factors predictive of a higher risk of grade 2 or higher late hematuria in patients with prostate cancer treated with high-dose radiotherapy.
Methods
For this purpose, we have analyzed 229 T1c-T3b prostate cancer patients treated with 3-dimensional conformal radiotherapy (3DCRT) in a prospective dose escalation study and with a minimum follow-up of 1 year. The mean radiation dose was 79 Gy (range 72.1 to 84.14 Gy) and the mean follow-up was 47 months (range 14 to 95). One hundred eighteen patients also received androgen deprivation (AD) for high-risk disease. Univariate and multivariate analysis (MVA) were performed to identify variables significantly associated with late hematuria.
Results
Of the 31 (14%) patients with grade 2 or higher genitourinary toxicity, hematuria was the main symptom in 24 (10.5%) with only 1 patient (0.5%) experiencing grade 3 hematuria. On statistical analysis, all the dosimetric parameters failed to show a significant correlation with grade 2 or higher hematuria. On MVA, prior transurethral resection of the prostate (TURP) was significantly associated with a higher risk of late hematuria (relative risk [RR] = 2.8; P = 0.026), whereas long-term AD was correlated with a significantly decreased risk (RR = 0.21; P = 0.019).
Conclusions
TURP was a relevant factor increasing 3 times the risk of late hematuria in prostate cancer patients treated with 3DCRT. Conversely, long-term AD resulted in a protective factor decreasing 5 times the risk of late hematuria. To our knowledge, this is the first study reporting a protecting effect of long-term hormones in late toxicity after radiotherapy.
aDepartment of Radiation Oncology, Hospital Universitario de la Princesa, Madrid, Spain
bDepartment of Medical Physics, Hospital Universitario de la Princesa, Madrid, Spain
cDepartment of Urology, Hospital Universitario de la Princesa, Madrid, Spain
Reprint requests: Almudena Zapatero, M.D., Ph.D., Radiation Oncology Department, Hospital Universitario de la Princesa, Diego de León 62, 28006 Madrid, Spain
ABSTRACT