Gross hematuria after prostate brachytherapy

Objectives. To summarize the clinical course of postimplant gross hematuria occurring past the perioperative period. Methods. From 1998 to 2000, 226 patients were treated for prostate carcinoma by implant alone or implant with supplemental external beam radiotherapy, using palladium-103 or iodine-125. Of these 226 patients, 9 had incomplete follow-up information and 2 died of causes other than prostate cancer. As a part of their routine follow-up, the remaining 215 patients were regularly mailed self-reporting questionnaires regarding urinary incontinence and hematuria. Postimplant computed tomography-based dosimetry was available for 211 (98%) of 215 patients. Dosimetric parameters were recorded for each patient using standardized methods. The rates of hematuria resolution were calculated using the product-limit (Kaplan-Meier) method. Statistical significance was determined using unpaired t testing. Results. Twenty-seven patients (13%) reported at least one episode of gross hematuria occurring more than 1 week after prostate implantation. The onset and duration of bleeding varied widely. Eleven patients reported only a single, isolated episode, and 16 patients reported multiple episodes, ranging from isolated sporadic to multiple times per day. No patient required a blood transfusion. The median time from the first episode of hematuria to resolution was 3 months. Of the 27 patients who reported hematuria, 88% had resolved by 24 months from time of first bleeding. Hematuria was unrelated to the maximal or mean urethral dose. Conclusions. Gross hematuria after brachytherapy resolves spontaneously in nearly all patients. Nonetheless, in patients without a recent workup for a genitourinary malignancy other than prostate cancer, a hematuria workup is reasonable. Because of the retrospective nature of this study and the highly variable presentation and clinical course of postimplant gross hematuria, we are unable to make firmer conclusions or recommendations regarding the role of follow-up urinalysis, urine cytology, anticoagulant medication, or supplemental beam radiation. Such an analysis will require a more controlled, prospective study of a large implant patient population.