Bothersome Hematospermia Following Stereotactic Body Radiation Therapy for Prostate Cancer

BackgroundHematospermia following prostate radiation therapy is a benign and often self-limiting side effect. However, it may be bothersome to some men and their partners with a negative impact on sexual quality of life (QOL). This study sought to evaluate the incidence, duration, and resolution of hematospermia in patients following stereotactic body radiation therapy (SBRT) for prostate cancer.Methods227 patients treated with SBRT from 2013 to 2019 at Georgetown University Hospital for localized prostate carcinoma with a minimum follow up of two years were included in this retrospective review of data that was prospectively collected. Patients who were greater than 70 years old and/or received hormonal therapy were excluded. Hematospermia was defined as bright red blood in the ejaculate. Time points for data collection included initial consultation, pre-treatment, 1-, 3-, 6-, 9-, 12-, 18-, 24-month. All patients were treated with the CyberKnife Radiosurgical System (Accuray). Data on hematospermia including duration, resolution and recurrence was collected. Utilization of 5-alpha reductase inhibitors was documented at each visit.Results227 patients (45 low-, 177 intermediate-, and 5 high-risk according to the D’Amico classification) at a median age of 65 years (range 47-70) received SBRT for their localized prostate cancer. The 2-year cumulative incidence of hematospermia was 5.6%(14 patients). For these patients, all but one patient (93%) saw resolution of their hematospermia by two years post-SBRT. The median time for hematospermia was 9 months post-treatment. Of the 14 patients who reported hematospermia, 70% were managed with 5-alpha reductase inhibitors. Hematospermia was transient in most patients with 70% of the men reporting resolution by the next follow-up visit.ConclusionThe incidence of bothersome hematospermia following SBRT was low. Hematospermia, as noted by other studies, often self-resolves. 5-alpha reductase inhibitors may lead to quicker resolution of bothersome hematospermia.

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Factors That Predict GU, GI, and Sexual Quality of Life (QOL) Outcomes 3 Years After Stereotactic Body Radiation Therapy (SBRT) for Early Prostate Cancer, Results From a Multi-institutional Phase 2 Trial

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2014.05.1435 ◽

2014 ◽

Vol 90 (1) ◽

pp. S459

Author(s):

D.B. Fuller ◽

D. Wong ◽

C. Medbery ◽

K. Underhill ◽

R.C. Chen

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Radiation Therapy ◽

Stereotactic Body Radiation Therapy ◽

Phase 2 ◽

Stereotactic Body Radiation ◽

Early Prostate Cancer ◽

Sexual Quality Of Life ◽

Phase 2 Trial

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Testosterone Levels and Sexual Quality of Life Following Stereotactic Body Radiation Therapy for Prostate Cancer: A Multi-institutional Analysis of Prospective Trials

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2017.06.1268 ◽

2017 ◽

Vol 99 (2) ◽

pp. E278

Author(s):

Y. Yuan ◽

D.B. Fuller ◽

G. Mardirossian ◽

M.L. Steinberg ◽

C.R. King ◽

...

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Radiation Therapy ◽

Stereotactic Body Radiation Therapy ◽

Institutional Analysis ◽

Testosterone Levels ◽

Stereotactic Body Radiation ◽

Sexual Quality Of Life ◽

Prospective Trials

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Incidence of patient-reported urinary incontinence after stereotactic body radiation therapy for clinically localized prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.254 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 254-254

Author(s):

Leonard N. Chen ◽

Jennifer Ai-Lian Woo ◽

Aditi Bhagat ◽

Rudy A. Moures ◽

Joy S. Kim ◽

...

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Urinary Incontinence ◽

Stereotactic Body Radiation Therapy ◽

Post Treatment ◽

University Hospital ◽

Localized Prostate Cancer ◽

Fractionated Radiotherapy ◽

Stereotactic Body Radiation ◽

Patient Reported

254 Background: Urinary incontinence (UI) following prostate radiotherapy is a rare toxicity that adversely affects a patient’s quality of life. The potential for hypofractionated radiotherapy to increase the risk of UI was investigated. This study sought to evaluate the incidence and severity of UI following stereotactic body radiation therapy (SBRT) for prostate cancer. Methods: Between February 2008 and August 2011, 216 men with clinically localized prostate cancer were treated definitively with SBRT at Georgetown University Hospital. Patients were treated to 35 to 36.25Gy in five fractions delivered with the CyberKnife (Accuray). UI was defined as self-reported involuntary urine loss and was assessed via the UI domain of the Expanded Prostate Index Composite (EPIC)-26 at baseline and at months 1, 3, 6, 9, 12, 18, and 24. EPIC scores range from 0 to 100 with lower values representing worsening incontinence. The minimally important difference (MID) was defined as a change of one-half standard deviation from the baseline. Results: The median age was 66 with a median prostate volume of 38 cc. The median follow-up was 3.2 years. Baseline UI was common with 22.0%, 26.2%, and 3.3% of patients reporting leaking, dribbling and pad usage, respectively. At two year post treatment, 31.1%, 34.7%, and 7.1% of patients reported some degree of incontinence based on leaking, dribbling and pad usage, respectively. Average EPIC UI domain scores showed a slow decline over the first two years following treatment. At two year post treatment, the median decreased from a baseline of 92.1 to 88.0. This change was statistically (p < 0.001) but not clinically significant (MID=6.7). The proportion of men feeling that their UI was a moderate to big problem increased from 1% at baseline to 6% at two years post treatment. Conclusions: SBRT for clinically localized prostate cancer was well tolerated with UI rates comparable to conventionally fractionated radiotherapy and brachytherapy. Greater than 90% of men who were pad-free prior to treatment remained pad-free two years following treatment. Less than 10% of men felt posttreatment UI was a moderate to big problem.

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The prostate clinical outlook (PCO) classifier for predicting biochemical recurrences in patients treated by stereotactic body radiation therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e16552 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e16552-e16552

Author(s):

Mi Jung Rho ◽

Jihwan Park ◽

Anatoly Dritschilo ◽

Sean P. Collins ◽

Simeng Suy ◽

...

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Stereotactic Body Radiation Therapy ◽

Cox Regression ◽

Prostate Cancer Risk ◽

Risk Groups ◽

University Hospital ◽

Conformal Radiation Therapy ◽

Stereotactic Body Radiation ◽

Radiological Staging

e16552 Background: Although prostate cancer risk classifiers have been developed for predicting surgical and radiation therapy outcomes, a classifier suitable for predicting biochemical recurrence (BCR) in patients undergoing stereotactic body radiation therapy (SBRT) remains to be defined. SBRT is delivered in large fractions of highly conformal radiation therapy and such treatments are believed to be radiobiologically more effective in treating prostate cancers. The aim of this study is to develop a new classifier specifically for informing patients electing to undergo prostate cancer treatment with SBRT. Methods: We have studied outcomes of 809 patients treated with SBRT between August 2007 and November 2016 at MedStar-Georgetown University Hospital. A Cox regression to BCR was performed and the Prostate Clinical Outlook (PCO) score was calculated at diagnosis based on age at diagnosis, clinical-radiological staging, pre-treatment PSA and Gleason score. Accuracy of the PCO classifier was assessed with concordance (c)-indexes. The results were also compared to classifications by D’Amico and National Comprehensive Cancer Network (NCCN) recurrence risk groups. Results: PCO total scores range from zero to 156 points. The PCO classifier splits patients into 3 risk-groups with the following 5-year BCR-free survival: for low-risk 98%; for intermediate-risk 95%; for high-risk 86%. Our classifier outperforms D’Amico and NCCN for all of the evaluated end-points, with concordance indices of 74 % versus 64 % and 66%, respectively. Conclusions: The PCO classifier is a potential tool for employing readily available parameters to stratify prostate cancer patients and to predict probabilities of BCR after SBRT.

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Clinical characteristics and management of late symptom flare following stereotactic body radiation therapy for clinically localized prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.194 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 194-194 ◽

Cited By ~ 2

Author(s):

Jennifer Ai-Lian Woo ◽

Leonard N. Chen ◽

Eric Oermann ◽

Viola Chen ◽

Thomas M. Yung ◽

...

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Stereotactic Body Radiation Therapy ◽

Short Form ◽

Urinary Symptoms ◽

University Hospital ◽

Localized Prostate Cancer ◽

Urinary Function ◽

Stereotactic Body Radiation ◽

Patient Reported

194 Background: Stereotactic body radiation therapy (SBRT) is increasingly utilized as primary treatment for clinically localized prostate cancer. While acute urinary symptoms are well recognized, late toxicities of SBRT have not been fully described. Here, we characterize the clinical features of late symptom flare and describe symptom management approaches. Methods: Two hudred sixteen patients with clinically localized prostate cancer were treated with SBRT between February 2008 and January 2011 at Georgetown University Hospital. Twenty-nine patients who experienced late-symptom flare were included in this retrospective analysis. Treatment was delivered using the CyberKnife (35 Gy to 36.25 Gy in five fractions). Prevalence of urinary toxicities was determined using CTCAE v.4. Patient-reported urinary symptoms were assessed using the American Urological Association Symptom Score (AUA) and the Expanded Prostate Cancer Index Composite (EPIC) short form. Results: Median age was 66 with 55% being of African descent. Late grade 2 frequency/urgency peaked at 12 months (17.2%), then returned to baseline at 18 months. Late grade 2 retention peaked at 18 months (65.5%), then returned to baseline at 24 months. Late grade greater than or equal to 1 dysuria peaked at nine months (25.0%), then returned to baseline at 24 months. Alpha-antagonist usage peaked at 18 months (85%) then decreased at 24 months. At 12 months, 21% required anti-inflammatories and/or urethral analgesics. Median AUA score rose from a baseline of 6 to 15 at 12 months, then returned to baseline by 24 months. EPIC urinary function and bother scores dropped to a nadir at 9 to 12 months post-treatment, then returned to baseline at 24 months. Conclusions: Symptom flare is a late syndrome consisting of various degrees of urinary frequency/urgency, retention and dysuria. It occurs approximately one year following SBRT, resolves spontaneously, and urinary function returns to baseline by two years. Early identification and initiation of conservative symptomatic management may decrease the need for invasive interventions. Anticipatory counseling prior to treatment may limit bother due to these transient urinary symptoms.

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