Urinary Retention and Incontinence after Low-Dose-Rate Brachytherapy for Prostate Cancer

Low dose rate permanent prostate brachytherapy is an excellent choice for men with localized prostate cancer. We review the contemporary understanding of genitourinary toxicity after prostate brachytherapy with particular attention directed toward urinary retention and incontinence. Urinary retention, though typically transient, has been reported in 1.5-34 % of patients, and significantly impacts health-related quality of life. Pre-treatment predictors include prostate size and high pre-treatment urinary symptom score. Validated nomograms have recently been developed to prospectively identify those at risk for urinary retention. In patients with refractory bladder outlet obstruction, a minimal transurethral resection of the prostate (TURP) is employed following a time interval sufficient for delivery of the full prescribed radiation dose. Urinary incontinence is uncommon following brachytherapy but is strongly associated with prior or subsequent TURP, where published incidence reports range from 0-19 %. Ongoing research seeks to identify genetic polymorphisms that may select individuals at greater risk of developing radiation related toxicities.