Combined curative radiotherapy including HDR brachytherapy and androgen deprivation in localized prostate cancer: A prospective assessment of acute and late treatment toxicity

Figures & data

Table I.  Treatment and follow-up related information

	Jun–Dec 1998	Jan–Dec 1999	Jan–Dec 2000	Jan–Dec 2001	Jan–Dec 2002	Jan–Jun 2003	Total
Total number of patients treated at Radiumhemmet	31	123	144	166	170	106	740
Patients followed up at:
Söder hospital Stockholm	3	40	61	47	27	40	218
Danderyd hospital Stockholm	1	0	3	4	0	5	13
Mälarhospital Eskilstuna	1	0	0	10	9	7	27
Other hospitals	1	1	1	0	1	2	6
Radiumhemmet Karolinska University hospital Stockholm	25	82	79	105	133	52	476

Figure 1. A schematic view of the treatment with two courses of EBRT (24 and 26 Gy respectively in 2 Gy fractions) and two HDR brachytherapy treatments of 10 Gy in the start and end of the interval.

Table II.  Categories for symptoms analyzed

Symptom item (no)	Categories
Question	1	2	3	4	5
Dysuria (A2)	Never	Occasionally	Sometimes	Often	Always
How often?
Urinary frequency (A5)	< = 1 h	1–2 h	2–3 h	3–4 h	> = 5 h
Micturition interval?
Hematuria (A8)	Never	Occasionally	Sometimes	Often	Always
Blood in the urine?
Urinary incontinence (A10)	Never	Occasionally	Sometimes	Every day	Always
How often?
Bowel urgency (B2)	Never	Occasionally	Sometimes	Often	Always
How often?
Stool frequency (B3)	Once	2–4 times	5–8 times	>8 times	Always
How many times/day?
Rectal pain (B5)	Never	Occasionally	Sometimes	Often	Always
How often?
Rectal bleeding (B8)	Never	Occasionally	>2/week	Daily	Always
How often?
Sexual desire (C2)	Not at all	A little	Quite a lot	Much	Highly
How much?
Erectile function (C3)	Not at all	Seldom	Sometimes	Often	Always
How often?
Sexual satisfaction (C6)	Not at all	Seldom	Sometimes	Often	Always
How often?

Table III.  Eligible patients and response rates in relation to assessment points

Table IV.  Patient characteristics at time of radiation therapy

	Number	%
Total number	525	100
Clinical stage (UICC)
T1	141	27
T2	182	35
T2–T3	144	10
T3	52	27
TX	6	1
Grade (WHO)
1	97	18
2	299	57
3	129	25
PSA (ng/ml)
< 10	198	38
10–20	183	35
21–50	117	22
> 50	25	5
Not known	2	0

Abbreviations: UICC = Union Internationale Contre le Cancer, WHO = World Health Organization.

Figure 2. Distribution of completed questionnaires at different assessment points. TAB = total androgen blockade.

Table V.  Prevalence of side effects – do you have urinary/bowel/sexual problems?

		% of patients responding yes
Months after RT	Number of patients	Urinary	Bowel	Sexual
Before RT no TAB	43	19	14	35
Before RT with TAB	118	27	13	59
2 months	173	49	45	77
4 months	178	42	38	74
10 months	126	38	52	65
16 months	120	42	42	72
22 months	88	36	34	65
28 months	69	33	45	68
34 months	48	25	31	69

Abbreviations: RT = radiotherapy, TAB = total androgen blockade.

Table VI.  Urinary tract symptoms

	% of patients (total number responding within brackets) having
Months after RT	Dysuria (O/A)	Frequency (> = 1/h)	Hematuria (yes)	Incontinence (daily)
Before RT	1% (148)	3% (149)	3% (150)	1% (151)
2 months	11% (155)	8% (153)	9% (156)	6% (158)
4 months	4% (161)	4% (164)	7% (165)	4% (163)
10 months	10% (117)	2% (117)	6% (117)	4% (117)
16 months	14% (112)	1% (112)	12% (114)	5% (114)
22 months	4% (81)	5% (82)	12% (83)	5% (83)
28 months	9% (64)	5% (65)	15% (62)	3% (65)
34 months	0% (47)	2% (47)	6% (47)	2% (47)

Abbreviations: RT = radiotherapy, O/A = often/always.

Table VII.  Bowel symptoms

	% of patients (total number responding within brackets) having
Months after RT	Urgency (O/A)	Frequency (>5/day)	Rectal pain (O/A)	Rectal bleeding (>2/week)
Before RT	4% (147)	3% (150)	1% (150)	1% (150)
2 months	12% (150)	7% (155)	4% (151)	1% (151)
4 months	6% (155)	6% (159)	2% (162)	3% (163)
10 months	7% (112)	4% (118)	3% (118)	5% (116)
16 months	9% (109)	7% (112)	3% (114)	6% (113)
22 months	5% (79)	4% (84)	0% (83)	1% (83)
28 months	3% (63)	3% (64)	2% (65)	3% (65)
34 months	4% (46)	4% (47)	2% (47)	7% (46)

Abbreviations: RT = radiotherapy, O/A = often/always.

Table VIII.  Sexual symptoms

	% of patients (total number responding within brackets) having
Months after RT	Desire (yes)	Durable erection (O/A)	Satisfaction (O/A)
Before RT no TAB	95% (37)	48% (37)	82% (37)
Before RT with TAB	65% (110)	13% (83)	40% (97)
2 months	50% (150)	4% (140)	12% (120)
4 months	71% (161)	11% (156)	26% (137)
10 months	78% (109)	17% (75)	40% (102)
16 months	83% (113)	17% (100)	40% (106)
22 months	80% (84)	15% (72)	45% (77)
28 months	77% (61)	20% (56)	36% (56)
34 months	89% (45)	14% (37)	41% (41)

Abbreviations: RT = radiotherapy, O/A = often/always, TAB = total androgen blockade.