Management of Radiation Therapy Oncology Group (RTOG) grade 4 urinary adverse events (UAEs) from radiotherapy for prostate cancer.

To describe the management of grade 4 Radiation Therapy Oncology Group (RTOG) urinary adverse events (UAEs) after radiotherapy (RT) for prostate cancer (PCa). We hypothesized grade 4 UAEs often require complex surgical management and subject patients to significant morbidity.

A single-center retrospective review, over a 6-year period (2010-2015), identified men with RTOG grade 4 UAEs after RT for PCa. RT was classified as combined modality therapy (radical prostatectomy (RP) followed by external beam radiotherapy (EBRT), EBRT + low-dose brachytherapy (LDR), EBRT + high-dose brachytherapy (HDR), or other combinations of RT) or single modality RT. UAEs were classified as outlet (urethral stricture, bladder neck contracture, prostate necrosis, or recto-urethral fistula) or bladder (contraction, necrosis, fistula, ureteral stricture, or hemorrhage).

We identified 73 men with a mean age of 73 years. Forty-four (60%) had combined modality therapy, consisting of RP + EBRT (19), high dose rate brachytherapy (HDR) + EBRT (19), low dose rate brachytherapy (LDR) + EBRT (5), and other combined modality RT (2). Twenty-nine (40%) patients had single modality therapy consisting of EBRT (4), HDR (11), LDR (12), or proton beam (2). UAEs were isolated to the bladder in 6 (8%), the outlet in 52 (71%), and both in 15 (21%). UAE management included: conservative in 21 (29%), indwelling catheters in 12 (16%), reconstructive in 19 (26%), and urinary diversion in 23 (32%). Reconstruction included: ureteral (4), recto-urethral fistula repair (2), and posterior urethroplasty (13), of which 14/16 (88%) surgeries with follow-up >90 days were successful.

Although the incidence of RTOG grade 4 UAEs after PCa radiation treatment is not well defined, their morbidity is significant, and approximately one third of patients with these high-grade complications require urinary diversion. Conversely only about a quarter of patients can be managed with conservative strategies or local surgeries. Reconstruction is successful in selected patients. This article is protected by copyright. All rights reserved.

BJU international. 2016 Jul 28 [Epub ahead of print]

Erik N Mayer, Jonathan D Tward, Mitchell Bassett, Sara M Lenherr, James M Hotaling, William O Brant, William T Lowrance, Jeremy B Myers

University of Utah, Department of Surgery, Center for Reconstructive Urology, and The Huntsman Cancer Institute, Salt Lake City, Utah., University of Utah, Department of Surgery, Center for Reconstructive Urology, and The Huntsman Cancer Institute, Salt Lake City, Utah., University of Utah, Department of Surgery, Center for Reconstructive Urology, and The Huntsman Cancer Institute, Salt Lake City, Utah., University of Utah, Department of Surgery, Center for Reconstructive Urology, and The Huntsman Cancer Institute, Salt Lake City, Utah., University of Utah, Department of Surgery, Center for Reconstructive Urology, and The Huntsman Cancer Institute, Salt Lake City, Utah., University of Utah, Department of Surgery, Center for Reconstructive Urology, and The Huntsman Cancer Institute, Salt Lake City, Utah., University of Utah, Department of Surgery, Center for Reconstructive Urology, and The Huntsman Cancer Institute, Salt Lake City, Utah., University of Utah, Department of Surgery, Center for Reconstructive Urology, and The Huntsman Cancer Institute, Salt Lake City, Utah.