Is hormone therapy a protective factor for late hematuria after high-dose radiotherapy in prostate cancer?

Objectives: To identify potential clinical and dosimetric factors predictive of a higher risk of grade 2 or higher late hematuria in patients with prostate cancer treated with high-dose radiotherapy.

Methods: For this purpose, we have analyzed 229 T1c-T3b prostate cancer patients treated with 3-dimensional conformal radiotherapy (3DCRT) in a prospective dose escalation study and with a minimum follow-up of 1 year. The mean radiation dose was 79 Gy (range 72.1 to 84.14 Gy) and the mean follow-up was 47 months (range 14 to 95). One hundred eighteen patients also received androgen deprivation (AD) for high-risk disease. Univariate and multivariate analysis (MVA) were performed to identify variables significantly associated with late hematuria.

Results: Of the 31 (14%) patients with grade 2 or higher genitourinary toxicity, hematuria was the main symptom in 24 (10.5%) with only 1 patient (0.5%) experiencing grade 3 hematuria. On statistical analysis, all the dosimetric parameters failed to show a significant correlation with grade 2 or higher hematuria. On MVA, prior transurethral resection of the prostate (TURP) was significantly associated with a higher risk of late hematuria (relative risk [RR] = 2.8; P = 0.026), whereas long-term AD was correlated with a significantly decreased risk (RR = 0.21; P = 0.019).

Conclusions: TURP was a relevant factor increasing 3 times the risk of late hematuria in prostate cancer patients treated with 3DCRT. Conversely, long-term AD resulted in a protective factor decreasing 5 times the risk of late hematuria. To our knowledge, this is the first study reporting a protecting effect of long-term hormones in late toxicity after radiotherapy.