Hematuria following post-prostatectomy radiotherapy (PPRT) is inadequately characterized. We performed a consecutive cohort study of patients treated with PPRT at our institution to characterize this complication including impact on patient-reported quality of life (PRQOL).
Patients with potential follow-up ≥ four years following PPRT were identified. Freedom from ≥grade 2 hematuria (G2H/FFG2H; macroscopic blood) was estimated using the Kaplan-Meier method. Predictors of G2H were assessed via log-rank tests and the Cox model. Urinary PRQOL by EPIC-26 was compared for patients with/without hematuria using mixed-effects regression.
216 men received PPRT (median 68.4 Gy [IQR, 68.0-68.4 Gy]) from 2007-2016 at a median 20 months (IQR, 9-45 months) after prostatectomy. Median follow-up was 72 months (IQR, 54-99 months). 85 men developed hematuria, 49 (58%) underwent cystoscopy, 13 (15%) required intervention, and 26 (31%) experienced recurrent hematuria. Eight-year FFG2H was 55%. G2H was highest in men treated with anticoagulation/antiplatelet therapy (AC/AP; HR 3.24, p<0.001), men with bladder V65 Gy≥43% (HR 1.97, p=0.004), and men with medication allergies (MA; HR 1.73, p=0.049); age<65 years (HR 0.81, p=0.374) and diabetes mellitus (HR 0.49, p=0.098) were not associated with G2H. Change in urinary continence (mean -3.5 [95% CI: 10.1,3.1]) and irritation/obstruction (mean -3.0 [95% CI: 5.8,-0.3]) domain scores did not exceed the minimally clinically important difference for men with/without hematuria.
Hematuria following PPRT is common, especially among men with MA and those on AC/AP; however, PPRT-related hematuria is typically self-limited. Limiting bladder V65 Gy may reduce PPRT-related hematuria.
The Journal of urology. 2022 Jan 20 [Epub ahead of print]
William Tyler Turchan, Dan Cutright, Tianming Wu, Jim X Leng, James J Dignam, Scott E Eggener, Stanley L Liauw
University of Chicago, Department of Radiation and Cellular Oncology, Chicago, Illinois., University of Chicago, Pritzker School of Medicine, Chicago, Illinois., University of Chicago, Department of Public Health Sciences, Chicago, Illinois., University of Chicago, Department of Surgery, Chicago, Illinois.