Assessment of lower urinary symptom flare with overactive bladder symptom score and International Prostate Symptom Score in patients treated with iodine-125 implant brachytherapy: long-term follow-up experience at a single institute

• Published in: BMC urology Vol. 17; no. 1; p. 62
• Main Authors: Miyake, Makito, Tanaka, Nobumichi, Asakawa, Isao, Hori, Shunta, Morizawa, Yosuke, Tatsumi, Yoshihiro, Nakai, Yasushi, Inoue, Takeshi, Anai, Satoshi, Torimoto, Kazumasa, Aoki, Katsuya, Hasegawa, Masatoshi, Fujii, Tomomi, Konishi, Noboru, Fujimoto, Kiyohide
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 14-08-2017; BioMed Central; BMC
• Subjects: Aged; Aged, 80 and over; Analysis; Antigens; Biologically effective dose; Bladder; Brachytherapy; Cancer therapies; Care and treatment; Classification; Complications and side effects; Decision making; Diabetes mellitus; Diagnosis; Dosimetry; Follow-Up Studies; Humans; International Prostate Symptom Score; Iodine; Iodine Radioisotopes - therapeutic use; Lower Urinary Tract Symptoms - blood; Lower Urinary Tract Symptoms - diagnosis; Lower Urinary Tract Symptoms - etiology; Male; Middle Aged; Overactive bladder symptom score; Physiological aspects; Prospective Studies; Prostate; Prostate cancer; Prostate-specific antigen; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - complications; Prostatic Neoplasms - radiotherapy; PSA bounce; Radiation therapy; Risk factors; Studies; Symptom Flare Up; Time Factors; Urinary bladder; Urinary Bladder, Overactive - blood; Urinary Bladder, Overactive - diagnosis; Urinary Bladder, Overactive - etiology; Urinary incontinence; Urinary tract; Urogenital system; Urology; Japan; Brachytherapy; Prostate cancer; Overactive bladder symptom score; Biologically effective dose; International Prostate Symptom Score; PSA bounce
• ISSN: 1471-2490; 1471-2490
• DOI: 10.1186/s12894-017-0251-1

The aim of this study was to evaluate the combined use of the overactive bladder symptom score (OABSS) and International Prostate Symptom Score (IPSS) as an assessment tool for urinary symptom flare after iodine-125 (
I) implant brachytherapy. The association between urinary symptom flare and prostate-specific antigen (PSA) bounce was investigated.
Changes in the IPSS and OABSS were prospectively recorded in 355 patients who underwent seed implantation. The percentage distribution of patients according to the difference between the flare peak and post-implant nadir was plotted to define significant increases in the scores. The clinicopathologic characteristics, treatment parameters, and post-implant dosimetric parameters were compared between the non-flare and flare groups. PSA bounce was defined as an elevation of ≥0.1 ng/mL or ≥0.4 ng/mL compared to the previous lowest value, followed by a decrease to a level at or below the pre-bounce value.
A clinically significant increase required an IPSS increase of at least 12 points and an OABSS increase of at least 6 points based on a time-course analysis of total scores and the QOL index. Assessment only by IPSS failed to detect 40 patients (11%) who had urinary symptom flare according to the OABSS. Univariate and multivariate analyses revealed that patients treated with higher biologically effective doses and those without diabetes mellitus had higher risks of urinary flare. There was no statistical correlation between the incidence and time of urinary symptom flare onset and that of a PSA bounce.
To our knowledge, this is the first report to prove the clinical potential of the OABSS as an assessment tool for urinary symptom flare after seed implantation. Our findings showed that persistent lower urinary tract symptoms after seed implantation were attributed to storage rather than to voiding issues. We believe that assessment with the OABSS combined with the IPSS would aid in decision-making in terms of timing, selection of a treatment intervention, and assessment of the outcome.