ORLANDO, FL, USA (UroToday.com) - Treating localized prostate cancer with hypofractionation with stereotactic body radiation (SBRT) may increase urine toxicity in patients with prior treatments for benign prostatic hyperplasia (BPH).
Researchers at Georgetown University Hospital undertook a retrospective analysis of 33 patients treated with SBRT for localized PCa (2009-2011), all of whom had prior BPH procedures. Each patient was treated using CyberKnife® dosing 35 Gy-36.25 Gy in 5 fractions. Urine toxicity was measured using CTCAE v.3. Patients self-reported urinary symptoms using the AUA symptom score. 
The median AUA symptom score after one year was 9. In this patient cohort with a median follow-up of 18.7 months, nine patients had a urinary toxicity of grade 2 or 3 (no one scored higher) and 12 patients had hematuria (at a median time of 6 months), and to date, nine have resolved that hematuria. Nine patients had cystoscopies (range 3-27 months), and of this group, eight had hyperemia (bleeding from the prostate urethra) and five of the eight also had bleeding from the bladder neck and wall.
The presenting author, Marie Kate Gurka, MD, provided this take-away message, “We retrospectively reviewed all of our patients who had been treated with SBRT at our institution (Georgetown University Hospital) and identified 33 patients who had had procedures for BPH prior to radiation therapy. We then looked at the incidence of hematuria following radiation treatment and found that approximately 30% of patients did have hematuria at some point after their treatment. Cystoscopy was done on nine of these patients near the time of their bleeding, and we discovered that most of the bleeding was likely from a hyperemic prostatic urethra and/or the bladder neck.”
Presented by Marie Kate Gurka, Zachary D. Horne, Leonard Chen, Sue Lei, Pranay Krishnan, Keith Kowalczyk, Simeng Suy, Anatoly Dritschilo, John H. Lynch, and Sean P. Collins at the 2013 Genitourinary Cancers Symposium - February 14 - 16, 2013 - Rosen Shingle Creek - Orlando, Florida USA
Georgetown University Hospital, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington, DC
Written by Karen Roberts, medical editor for UroToday.com
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