Complications of prostate cancer seed implantation

Compared with radical surgery and external radiotherapy, the incidence of various complications of prostate cancer seed implantation is low and the complications are easier to handle. What are the complications of prostate cancer seed implantation?

Complications of particle implantation therapy include short-term complications and long-term complications. Complications that occur within one year are usually defined as short-term complications, while complications that occur after one year are defined as long-term complications. These complications mainly involve the urinary tract, rectum, and sexual function.

1. Brachytherapy is less invasive and is easy for patients to accept. Compared with radical prostatectomy, brachytherapy is less invasive, and the incidence of impotence and urinary incontinence is low, but its urinary tract irritation symptoms are more obvious than radical prostatectomy. Common early postoperative urinary tract irritation symptoms include frequent urination, urgency, dysuria, weak urination, incomplete urination, and increased nocturia, which are very common within 1 month after surgery. However, most patients will gradually return to normal levels within 6 to 12 months. Combined external radiotherapy will aggravate lower urinary tract symptoms. The incidence of acute urinary retention is reported in the literature to be around 5%, which is related to high preoperative IPSS scores, large prostate volume (>35ml) and residual urine volume greater than 200ml. Long-term use of α-receptor blockers can alleviate the symptoms of postoperative urinary obstruction and reduce the incidence of urinary retention. The incidence of postoperative urinary incontinence is low, ranging from 0% to 11%, and is higher in patients with a history of TURP surgery.

2. One of the main advantages of particle therapy is the protection of sexual function. Most reports believe that the postoperative erectile function retention rate can reach more than 80%. The cause of postoperative erectile dysfunction is still unclear. Some authors have suggested that it may be related to radiation damage to the vascular nerve bundle. Some articles have pointed out that the radiation dose received by the urethral bulb has a strong correlation with postoperative erectile dysfunction. The retention rate of erectile function is related to the preoperative erectile function status, the radiation dose received by the prostate, and whether there is endocrine therapy or external radiotherapy. Merick et al. reported that 181 patients with good preoperative sexual function received treatment and followed up for 6 years. The sexual function retention rate of those who received brachytherapy + external radiotherapy was 39%, while that of those who did not receive external radiotherapy was 52%. As the follow-up time increases, the retention rate of erectile function is also decreasing. Stock et al. reported that the retention rate was 79% after 3 years and 59% after 6 years.

3. Proctitis is also a common complication of brachytherapy, with an incidence rate of 1% to 21%. It is often manifested by rectal irritation symptoms such as increased bowel movements, tenesmus, excessive rectal mucus or intermittent mild blood in the stool. It is often self-limiting and can generally be treated symptomatically. In severe cases, rectal ulcers and even urethrorectal fistulas may occur, but they are very rare.