BACKGROUND - After radiotherapy (RT) for prostate cancer (PCa), several patients reported lower urinary tract symptoms (LUTS) due to damage and discontinuation of the glycosaminoglycan layer of the bladder. Instillation of hyaluronic acid and chondroitin sulfate (HA-CS) represents replenishment therapy of the glycosaminoglycan layer.
The aim of the study is to evaluate the efficacy and safety of HA-CS in men with symptomatic cystitis after RT for PCa.
MATERIALS AND METHODS - Eighty consecutive men were treated with RT for PCa; 30 of these (37.5%) reported clinically relevant LUTS and associated bother as measured by the Interstitial Cystitis Symptom Index and Problem Index (ICSI/ICPI) Questionnaire 3 months after RT. Symptomatic patients received instillation therapy with HA-CS weekly for the first month and then at weeks 6, 8, and 12. All patients completed the ICSI/ICPI questionnaire before and after RT and at the end of HA-CS treatment.
RESULTS - HA-CS significantly reduced postradiation LUTS (P < .001) and bother (P = .006). Age, Gleason score, and radiation dose were the main determinants of worsening of LUTS after radiation (ICSI score baseline vs. postradiation: P = .047, .043, and .023). In multivariate analysis, only age influenced LUTS worsening after RT (P = .01). Age, radiation dose, and radiation toxicity were related to recovery of LUTS (ICSI score postradiation vs. post-HA-CS P = .041, P = .050, and P = .046). In multivariate analysis, no factor was statistically significant.
CONCLUSIONS - A remarkable worsening of symptoms and bother was observed after RT. HA-CS instillation is a safe treatment and resulted in an improvement of LUTS irrespective of age and clinical features, with full recovery of urinary bother.
Clinical genitourinary cancer. 2016 Feb 08 [Epub ahead of print]
Mauro Gacci, Omar Saleh, Claudia Giannessi, Tommaso Chini, Pier Andrea Della Camera, Beatrice Detti, Lorenzo Livi, Enrico Finazzi Agro, Vincenzo Li Marzi, Andrea Minervini, Marco Carini, Matthias Oelke, Stavros Gravas, Sergio Serni
Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Department of Urology, University of Florence, Careggi Hospital, Florence, Italy. Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Department of Radiation Therapy, University of Florence, Careggi Hospital, Florence, Italy., Department of Radiation Therapy, University of Florence, Careggi Hospital, Florence, Italy., Department of Urology, Tor Vergata University, Rome, Italy., Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Department of Urology, Hannover Medical School, Hannover, Germany., Department of Urology, University Hospital of Larissa, Larissa, Greece., Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.