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Natural history of lower urinary tract symptoms among men undergoing stereotactic body radiation therapy for prostate cancer with and without a Rectal Hydrogel Spacer

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Abstract

Purpose

Stereotactic body radiation therapy (SBRT) is increasingly used for prostate cancer, but has morbidity as both the bladder and rectum are radiated during treatment. Our goal was to document and compare lower urinary tract symptoms (LUTS) among men who underwent SBRT with and without SpaceOAR hydrogel (Augmenix, Inc., Bedford, MA).

Methods

We performed a retrospective analysis of 87 men (50 SpaceOAR and 37 non-SpaceOAR) who underwent SBRT. Primary outcomes were patient reported symptoms during radiation therapy, pharmacotherapy usage, and urologic and bowel survey scores up to 6-months post-SBRT.

Results

78% of men were on α-inhibitors at the end of SBRT, an increase from 27.6% baseline usage (p < 0.001). Post-SBRT urinary frequency was more common in the non-SpaceOAR group versus the SpaceOAR group (68% versus 38%, p = 0.006), as was nocturia (35% vs. 8%, p = 0.002). Acute gastrointestinal symptoms did not differ. 58.8% of men were on α-inhibitors at 6-months of follow-up post-SBRT, an increase from 27.6% baseline usage (p < 0.001). Importantly, there was a difference of α-inhibitor use between non-SpaceOAR and SpaceOAR groups at the end of SBRT and at 1.5-, 3-, and 6-months follow up (86% vs. 53% [p = 0.002], 83% vs. 53% [p = 0.005], 72% vs. 49% [p = 0.038], respectively).

Conclusion

LUTS after SBRT remains a significant problem for men undergoing treatment for prostate cancer. LUTS affects men during and up to 6-months following SBRT. Owing to these increased LUTS, preemptive minimally invasive solutions and their mechanisms of protection, including the SpaceOAR, should be further investigated.

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Funding

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Author notes

  1. Josephine Kang and Bilal Chughtai joint last authorship.

Authors and Affiliations

  1. Weill Cornell Medical College, New York, NY, USA

    Mark N. Alshak & Andrew Eidelberg

  2. Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA

    Silvia Formenti, Himanshu Nagar & Josephine Kang

  3. Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA

    Susana Martinez Diaz & Bilal Chughtai

  4. Department of Urology, University of Texas Health Science Center, San Antonio, Texas, USA

    Michelina D. Stoddard

Authors
  1. Mark N. Alshak
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  2. Andrew Eidelberg
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  3. Susana Martinez Diaz
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  4. Michelina D. Stoddard
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  5. Silvia Formenti
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  6. Himanshu Nagar
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  7. Josephine Kang
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  8. Bilal Chughtai
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Contributions

MNA: protocol/project development, data collection or management, data analysis, manuscript writing/editing. AE: protocol/project development, data collection or management, data analysis, manuscript writing/editing. SMD: protocol/project development, data analysis, manuscript writing/editing. MDS: protocol/project development, data analysis, manuscript writing/editing. SF: protocol/project development, data analysis, manuscript writing/editing. HN: protocol/project development, data analysis, manuscript writing/editing. JK: protocol/project development, data analysis, manuscript writing/editing. BC: protocol/project development, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Bilal Chughtai.

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All authors have no conflicts of interest to declare.

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Data is available from authors upon reasonable request.

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Study was approved by the WCM Institutional Review Board (IRB #1601016896).

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Waived.

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Alshak, M.N., Eidelberg, A., Diaz, S.M. et al. Natural history of lower urinary tract symptoms among men undergoing stereotactic body radiation therapy for prostate cancer with and without a Rectal Hydrogel Spacer. World J Urol 40, 1143–1150 (2022). https://doi.org/10.1007/s00345-022-03953-0

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  • DOI: https://doi.org/10.1007/s00345-022-03953-0

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