Chronic pelvic pain following prostate brachytherapy: A case report

Purpose To alert physicians and potential patients that chronic postimplant pelvic pain syndromes can occur, and that dosimetric parameters (i.e., implant technique) may predispose patients to it. Methods and materials The authors are currently following 3 prostate brachytherapy patients with what appear to be chronic radiation-related pelvic pain, variously exacerbated by urination or perineal pressure. The 3 patients were identified in the course of routine follow-up, and do not represent a concerted attempt to identify such patients from a larger group of patients being followed by the authors. Three control groups of 10 patients each treated with 125I, 103Pd, or 103Pd + external beam radiation and with no reported dysuria at 6 months postimplant were taken from two ongoing prospective trials. The 3 patients reported here were each administered a brief questionnaire regarding the effect of their urinary pain on daily activities. Results Patients with chronic pain tended to have high central prostatic doses, at least on some planes. Maximal, mean, and median urethral doses were higher for patients with chronic pain, but there was some overlap with control patients. The prostate V100s were similar between patients with chronic pain and controls, but there was a trend toward higher V200s and V300s in pain syndrome patients. Conclusion Recalcitrant brachytherapy-related pelvic pain is an uncommon occurrence that may be partly related to higher central prostatic doses.