Haematuria after prostate brachytherapy

What's known on the subject? and What does the study add? Previous descriptions of haematuria after brachytherapy are limited. This study characterizes the long-term incidence and associated clinical risk factors of haematuria after prostate brachytherapy. Objective To characterize the incidence and clinical history of gross haematuria after prostate brachytherapy. To identify treatment risk factors for the development of gross haematuria in this setting. Patients and Methods We reviewed haematuria outcomes collected prospectively in 2454 patients treated with transperineal prostate brachytherapy over a 20-year period at a single institution. Patients were followed for a median of 5.9 years. The association of haematuria with age, pretreatment PSA, ethnicity, clinical tumour stage, Gleason score, prostate volume, isotope (iodine 125 or palladium 103), biologically effective dose (BED), external beam radiation, androgen deprivation, development of urinary retention and occurrence of biochemical failure was investigated. Results A total of 218 men (8.9%) reported gross haematuria at a median time of 772.2 days after implantation. Haematuria was associated with prostate volume >40 cm³ (P < 0.01), use of external beam radiation (P < 0.01), Gleason score >7 (P = 0.037), Asian ethnicity (P < 0.001), BED >200 Gy (P = 0.01), and freedom from biochemical failure (P = 0.004). On multivariate analysis, prostate volume >40 cm³ (P = 0.002), external beam radiation, (P = 0.001), and freedom from biochemical failure (P = 0.035) were predictors of haematuria. Conclusions Late gross haematuria was observed in a small proportion of men after brachytherapy and may occur with considerable latency. Larger prostate glands, freedom from biochemical failure and external beam radiation are risk factors.