Randomized trial to assess the efficacy of intraoperative steroid use in decreasing acute urinary retention after transperineal radioactive iodine-125 implantation for prostate cancer.

摘要

BACKGROUND: Acute urinary retention is a potential complication of brachytherapy, with the literature estimating that 5% to 22% of patients require catheterization within 48 hours after implantation. In theory, postimplantation edema could be reduced by using intraoperative steroids. A prospective trial was conducted randomizing patients to a single intraoperative dose of dexamethasone versus no steroid use. METHODS: In all, 196 evaluable patients who received iodine-125 (I(125)) interstitial brachytherapy alone as definitive treatment for low-to-intermediate risk prostate cancer were randomized to receive either dexamethasone at a dose of 6 mg administered intravenously intraoperatively (Arm A) or no steroids (Arm B). All patients completed the International Prostate Symptom Score before treatment. Patients were contacted by telephone 72 to 96 hours after treatment and the need for catheterization was reported. RESULTS: Between 2003 and 2005, 99 patients received steroids on treatment Arm A and 97 patients were treated according to control Arm B. Treatment arms were balanced with respect to pretreatment characteristics. A total of 3 patients required catheterization (2 in Arm A and 1 in Arm B). The overall rate of catheterization was 1.5%, with no statistically significant difference noted between treatment arms. The 3 patients requiring catheterization had no statistical differences from other patients with respect to pretreatment characteristics, number of seedseedles used, or postimplantation computed tomography volume of the prostate. CONCLUSIONS: There was no statistically significant difference noted between treatment arms in the current study, leading the authors to conclude that intraoperative dexamethasone did not decrease the rate of catheterization required after brachytherapy. The overall rate of postimplantation catheterization in the current study was 1.5%, which is lower than reported elsewhere in the literature and in a retrospective review from the study institution.