Follow-up/Toxicity

Question 1

What are the most common acute and late side effects from prostate BT?

Answer 1

Obstructive and irritative urinary Sx and impotence are side effects that are generally experienced d/t prostate seed implantation. Rectal toxicity is relatively rare.

Question 2

Are phosphodiesterase inhibitors effective for prostate brachy–related erectile dysfunction?

Answer 2

Yes. ∼50% of pts who have erectile dysfunction after prostate BT can achieve erections useful for intercourse with the use of phosphodiesterase inhibitors.

Question 3

How does the intensity and timing of urinary irritation differ b/t men treated with I-125 vs. Pd-103?

Answer 3

Irritative Sx are more intense and occur earlier but resolve more quickly in pts treated with Pd-103 compared to I-125. (Herstein et al., Cancer 2005)

Question 4

What acute toxicities are associated with prostate BT?

Answer 4

Prostate BT pts experience acute worsening of urinary Sx (frequency, urgency, hesitancy, and weak stream). Acute urinary retention is rare (∼3% require catheterization). Acute irritative and/or obstructive Sx tend to be slightly better with HDR.

Question 5

What late toxicities are associated with prostate BT?

Answer 5

Relatively common: Impotence, mild increased urinary irritative/obstructive Sx, and mild rectal bleeding. Rare: Significant late GU toxicity (e.g., urethral strictures), significant rectal bleeding. Very rare: rectal fistula, seed embolization, 2nd cancers

Question 6

How do QOL outcomes compare for BT monotherapy vs. EBRT?

Answer 6

Short- & long-term QOL comparable (Sanda, NEJM 2008; Prado, JCO 2010). In general, erectile function modestly better with BT. Resolution of urinary irritative Sx is less after BT.