Nomograms to predict late urinary toxicity after prostate cancer radiotherapy

World J Urol. 2014 Jun;32(3):743-51. doi: 10.1007/s00345-013-1146-8. Epub 2013 Aug 29.


Objective: To analyze late urinary toxicity after prostate cancer radiotherapy (RT): symptom description and identification of patient characteristics or treatment parameters allowing for the generation of nomograms.

Methods: Nine hundred and sixty-five patients underwent RT in seventeen French centers for localized prostate cancer. Median total dose was 70 Gy (range, 65-80 Gy), using different fractionations (2 or 2.5 Gy/day) and techniques. Late urinary toxicity and the corresponding symptoms (urinary frequency, incontinence, dysuria/decreased stream, and hematuria) were prospectively assessed in half of the patients using the LENT-SOMA classification. Univariate and multivariate Cox regression models addressed patient or treatment-related predictors of late urinary toxicity (≥grade 2). Nomograms were built up, and their performance was assessed.

Results: The median follow-up was 61 months. The 5-year (≥grade 2) global urinary toxicity, urinary frequency, hematuria, dysuria, and urinary incontinence rates were 15, 10, 5, 3 and 1 %, respectively. The 5-year (≥grade 3) urinary toxicity rate was 3 %. The following parameters significantly increased the 5-year risk of global urinary toxicity (≥grade 2): anticoagulant treatment (RR = 2.35), total dose (RR = 1.09), and age (RR = 1.06). Urinary frequency was increased by the total dose (RR = 1.07) and diabetes (RR = 4). Hematuria was increased by anticoagulant treatment (RR = 2.9). Dysuria was increased by the total dose (RR = 1.1). Corresponding nomograms and their calibration plots were generated. Nomogram performance should be validated with external data.

Conclusions: The first nomograms to predict late urinary toxicity but also specific urinary symptoms after prostate RT were generated, contributing to prostate cancer treatment decision.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Dose-Response Relationship, Radiation
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Nomograms*
  • Predictive Value of Tests
  • Prospective Studies
  • Prostatic Neoplasms / radiotherapy*
  • Prostatic Neoplasms / urine
  • Radiation Injuries / diagnosis*
  • Radiation Injuries / physiopathology
  • Urinalysis
  • Urinary Tract / radiation effects*
  • Urination*
  • Urologic Diseases / etiology*
  • Urologic Diseases / physiopathology