Late complications of PB include irritative voiding symptoms, persistent urinary retention, rectal urgency, bowel frequency, rectal bleeding or ulceration, and prostatorectal fistulas.38-41 In one series, 19 of 109 patients (19%) developed persistent, bright-red rectal bleeding, from 1 to 28 months following 125I implantation.42 Urinary retention requiring intermittent or long-term urinary catheterization is uncommon, occurring in fewer than 5%.43 In a second report of 105 men treated an average of 5.2 years before survey, bowel symptoms were uncommon (4-9%) unless external beam irradiation had also been administered.38
Compared to 3D-CRT, PB is associated with both more acute and chronic urinary morbidity. This was illustrated in one series that compared outcomes in men with favorable risk prostate cancer who received either 3D-CRT (n = 137) or transperineal 125I implantation (n = 145).7 In the PB group, 31% had grade 2 urinary symptoms persisting after 1 year, and the median duration of grade 2 urinary symptoms was 23 months (range 12-70 months). In contrast, acute grade 2 urinary symptoms resolved within 4-6 weeks after completion of 3D-CRT, and at 5 years, only 8% still had ^ grade 2 urinary toxicity. The 5-year likelihood of post-treatment erectile dysfunction among patients who were initially potent before therapy was similar between the two groups, as was the 5-year likelihood of grade 2 late rectal toxicity (6% and 11%, respectively, for 3D-CRT and PB). The impact of brachytherapy on potency was evaluated in several reports38,44,45 as follows.
• In one series, 416 men underwent radioactive seed implantation for T1-2 prostate cancer.44 In the 313 men who were potent prior to treatment, potency was retained in 79% at 3 years and 59% at 6 years.
• Similar results were noted in a second review of 482 men who were potent before treatment.45 At 5 years, potency was preserved overall in 53%; 76% of those treated with PB monotherapy maintained potency.
• In a third report surveying patient-reported symptoms at an average of 5.2 years following treatment, complete impotence (51%) and erections inadequate for penetration without manual assistance (72%) were seen in men who had full erections at baseline.38.
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