gms | German Medical Science

Purpose: To evaluate the incidence, persistence and correlates of late side-effects > grade II in patients with definitive CRT of localized prostate cancer.

Material and Methods: 385 patients with localized prostate cancer (T1-T4N0M0) were retrospectively analyzed. Median follow-up was 60 months (12-128 m.). The median dose to the prostate was 70 Gy (59-72 Gy), 78% of the patients received short term neoadjuvant hormonal therapy. Late side-effects were graded according to a modified RTOG score. Every macroscopic bleeding was scored at least as grade 2 toxicity.

Results: The incidence of grade II and III late side effects at 5 years according to the Kaplan-Meier estimates is listed in table 1 [Tab. 1]. No grade IV or V toxicity was observed. Rectal bleeding was mostly minor and intermittent without affecting the patient’s daily activities. The percentages of side effects that did not persist until the last date of follow-up are listed in table 1 [Tab. 1]. The incidence of any grade III rectal side-effect at 5 years was 4%. In 65% of these patients the toxicity did not persist. The incidence of any grade III urologic side-effect at 5 years was 6%. In 54% of these patients the toxicity did not persist. In multivariate analysis acute grade II/III rectal toxicity was associated with a higher incidence of late grade II/III rectal toxicity (p<0.001). Acute grade II/III urologic toxicity and concomitant peripheral arterial disease were associated with a higher incidence of late grade II/III urologic toxicity (p<0.001 and p=0.006, respectively).

Conclusions: Conformal radiation therapy for prostate cancer is associated with a low incidence of severe late side-effects. In the majority of the patients with grade III toxicity these symptoms did not persist. Acute grade II/III toxicity is a predictor for late grade II/III side-effects.