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Nomograms to predict late urinary toxicity after prostate cancer radiotherapy

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Abstract

Objective

To analyze late urinary toxicity after prostate cancer radiotherapy (RT): symptom description and identification of patient characteristics or treatment parameters allowing for the generation of nomograms.

Methods

Nine hundred and sixty-five patients underwent RT in seventeen French centers for localized prostate cancer. Median total dose was 70 Gy (range, 65–80 Gy), using different fractionations (2 or 2.5 Gy/day) and techniques. Late urinary toxicity and the corresponding symptoms (urinary frequency, incontinence, dysuria/decreased stream, and hematuria) were prospectively assessed in half of the patients using the LENT-SOMA classification. Univariate and multivariate Cox regression models addressed patient or treatment-related predictors of late urinary toxicity (≥grade 2). Nomograms were built up, and their performance was assessed.

Results

The median follow-up was 61 months. The 5-year (≥grade 2) global urinary toxicity, urinary frequency, hematuria, dysuria, and urinary incontinence rates were 15, 10, 5, 3 and 1 %, respectively. The 5-year (≥grade 3) urinary toxicity rate was 3 %. The following parameters significantly increased the 5-year risk of global urinary toxicity (≥grade 2): anticoagulant treatment (RR = 2.35), total dose (RR = 1.09), and age (RR = 1.06). Urinary frequency was increased by the total dose (RR = 1.07) and diabetes (RR = 4). Hematuria was increased by anticoagulant treatment (RR = 2.9). Dysuria was increased by the total dose (RR = 1.1). Corresponding nomograms and their calibration plots were generated. Nomogram performance should be validated with external data.

Conclusions

The first nomograms to predict late urinary toxicity but also specific urinary symptoms after prostate RT were generated, contributing to prostate cancer treatment decision.

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Acknowledgments

Authors would like to thank Marian LEE for her critical review.

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Authors and Affiliations

  1. Department of Urology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France

    Romain Mathieu

  2. Inserm U642, LTSI, Rennes, France

    Juan David Ospina Arango, Jian Zhu, Oscar Acosta & Renaud De Crevoisier

  3. Centre Alexis Vautrin, Vandoeuvre les Nancy, France

    Véronique Beckendorf

  4. Centre Eugene Marquis, Rennes, France

    Jean-Bernard Delobel, Ciprian Chira, Elisabeth Le Prisé, Khemara Gnep & Renaud De Crevoisier

  5. Institut Gustave-Roussy, Villejuif, France

    Taha Messai & Alberto Bossi

  6. Centre Hospitalier Universitaire, Poitiers, France

    Stéphane Guerif

  7. Hôpital de la Pitié-Salpétrière, Paris, France

    Jean-Marc Simon

  8. Centre Henry Becquerel, Rouen, France

    Bernard Dubray

  9. Hôpital Henry Mondor, Créteil, France

    Jean-Léon Lagrange

  10. Centre Léon Berard, Lyon, France

    Pascal Pommier

  11. School of Statitstics, National University of Colombia, Campus Medellin, Medellin, Colombia

    Juan David Ospina Arango

Authors
  1. Romain Mathieu
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  2. Juan David Ospina Arango
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  3. Véronique Beckendorf
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  4. Jean-Bernard Delobel
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  5. Taha Messai
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  6. Ciprian Chira
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  7. Alberto Bossi
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  8. Elisabeth Le Prisé
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  9. Stéphane Guerif
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  10. Jean-Marc Simon
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  11. Bernard Dubray
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  12. Jian Zhu
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  13. Jean-Léon Lagrange
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  14. Pascal Pommier
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  15. Khemara Gnep
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  16. Oscar Acosta
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  17. Renaud De Crevoisier
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Corresponding author

Correspondence to Romain Mathieu.

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Mathieu, R., Arango, J.D.O., Beckendorf, V. et al. Nomograms to predict late urinary toxicity after prostate cancer radiotherapy. World J Urol 32, 743–751 (2014). https://doi.org/10.1007/s00345-013-1146-8

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  • DOI: https://doi.org/10.1007/s00345-013-1146-8

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