Purpose
Hematuria following post-prostatectomy radiotherapy (PPRT) is inadequately characterized. We performed a consecutive cohort study of patients treated with PPRT at our institution to characterize this complication including impact on patient-reported quality of life (PRQOL).
Materials and Methods
Patients with potential follow-up ≥ four years following PPRT were identified. Freedom from ≥grade 2 hematuria (G2H/FFG2H; macroscopic blood) was estimated using the Kaplan-Meier method. Predictors of G2H were assessed via log-rank tests and the Cox model. Urinary PRQOL by EPIC-26 was compared for patients with/without hematuria using mixed-effects regression.
Results
216 men received PPRT (median 68.4 Gy [IQR, 68.0-68.4 Gy]) from 2007-2016 at a median 20 months (IQR, 9-45 months) after prostatectomy. Median follow-up was 72 months (IQR, 54-99 months). 85 men developed hematuria, 49 (58%) underwent cystoscopy, 13 (15%) required intervention, and 26 (31%) experienced recurrent hematuria. Eight-year FFG2H was 55%. G2H was highest in men treated with anticoagulation/antiplatelet therapy (AC/AP; HR 3.24, p<0.001), men with bladder V65 Gy≥43% (HR 1.97, p=0.004), and men with medication allergies (MA; HR 1.73, p=0.049); age<65 years (HR 0.81, p=0.374) and diabetes mellitus (HR 0.49, p=0.098) were not associated with G2H. Change in urinary continence (mean -3.5 [95% CI: 10.1,3.1]) and irritation/obstruction (mean -3.0 [95% CI: 5.8,-0.3]) domain scores did not exceed the minimally clinically important difference for men with/without hematuria.
Conclusions
Hematuria following PPRT is common, especially among men with MA and those on AC/AP; however, PPRT-related hematuria is typically self-limited. Limiting bladder V65 Gy may reduce PPRT-related hematuria.