OBJECTIVES: After prostate brachytherapy, pronounced urinary irritative symptomatology occurs in a substantial minority of patients. In this study, we evaluated the impact of trospium chloride in prostate brachytherapy patients with symptoms consistent with an overactive bladder (OAB). METHODS: From January 1999 through December 2005, 69 permanent prostate brachytherapy patients were identified who received trospium as first-line treatment for OAB. The median interval from implant to initiation of trospium was 23.4 months. Before trospium, we obtained a postvoid residual urine assessment (PVR) and International Prostate Symptom Score (IPSS) for all patients. IPSS resolution was defined as a return to within 2 points of the pre-brachytherapy value and individual IPSS question resolution was defined by a decrease of at least 1 point. RESULTS: The mean patient age was 66.0 years, with a pre-brachytherapy prostate volume of 31.0 cm(3) and a mean preimplant IPSS of 6.5. At trospium initiation, the mean IPSS was 9.6 with a mean PVR of 12.3 mL. IPSS normalization was documented in 55 (79.7%) patients. Twelve months after trospium initiation, the IPSS had decreased by a mean of 4.3 points with the improvement most pronounced for urgency. After trospium, no clinically significant differences were noted in the mean PVR. Twenty-two patients discontinued trospium as a result of the absence of a clinical response or pharmacologic side effects, or after complete resolution of symptoms. CONCLUSIONS: Nearly 80% of patients with brachytherapy-related detrusor overactivity responded favorably to trospium with improvements in IPSS (especially urgency). This was accomplished with an acceptable morbidity profile.
OBJECTIVES: After prostate brachytherapy, pronounced urinary irritative symptomatology occurs in a substantial minority of patients. In this study, we evaluated the impact of trospium chloride in prostate brachytherapy patients with symptoms consistent with an overactive bladder (OAB). METHODS: From January 1999 through December 2005, 69 permanent prostate brachytherapy patients were identified who received trospium as first-line treatment for OAB. The median interval from implant to initiation of trospium was 23.4 months. Before trospium, we obtained a postvoid residual urine assessment (PVR) and International Prostate Symptom Score (IPSS) for all patients. IPSS resolution was defined as a return to within 2 points of the pre-brachytherapy value and individual IPSS question resolution was defined by a decrease of at least 1 point. RESULTS: The mean patient age was 66.0 years, with a pre-brachytherapy prostate volume of 31.0 cm(3) and a mean preimplant IPSS of 6.5. At trospium initiation, the mean IPSS was 9.6 with a mean PVR of 12.3 mL. IPSS normalization was documented in 55 (79.7%) patients. Twelve months after trospium initiation, the IPSS had decreased by a mean of 4.3 points with the improvement most pronounced for urgency. After trospium, no clinically significant differences were noted in the mean PVR. Twenty-two patients discontinued trospium as a result of the absence of a clinical response or pharmacologic side effects, or after complete resolution of symptoms. CONCLUSIONS: Nearly 80% of patients with brachytherapy-related detrusor overactivity responded favorably to trospium with improvements in IPSS (especially urgency). This was accomplished with an acceptable morbidity profile.
Authors: Zaker Rana; Robyn A Cyr; Leonard N Chen; Brian S Kim; Rudy A Moures; Thomas M Yung; Siyuan Lei; Brian T Collins; Simeng Suy; Anatoly Dritschilo; John H Lynch; Sean P Collins Journal: Front Oncol Date: 2014-10-21 Impact factor: 6.244