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Comparative Complications of Cryotherapy vs. Brachytherapy in Men With Localized Prostate Cancer
Stephen B. Williams, M.D., Yin Lei, M.D., Stuart R. Lipsitz, Ph.D., Anthony V. D’Amico, M.D., PhD., Jim C. Hu, M.D., MPH.
Brigham and Women's Hospital, Boston, MA, USA.

Background
Despite increased popularity for ablative techniques such as cryotherapy and brachytherapy for localized prostate cancer, population-based outcomes remain largely unknown. We sought to characterize and compare outcomes of cryotherapy vs. brachytherapy.
Methods
Using SEER - Medicare linked data from 2001-2005, we identified 12,851 men aged ≥ 65 years
diagnosed with non-metastatic prostate cancer who underwent primary cryotherapy (n=1193) and brachytherapy (n=11,658) with at least 2 years of follow-up. We compared rates of urinary (cystitis/hematuria, urinary obstruction, urethral fistula, incontinence) and bowel complications (proctitis/bleeding, rectal injury/fistula) and erectile dysfunction (ED) following cryotherapy vs. brachytherapy. We also constructed logistic regression models to characterize factors associated with complications after cryotherapy and brachytherapy.
Results
Within our study cohort, use of cryotherapy increased from 7.9% in 2001 to 32.2% in 2005. Men undergoing cryotherapy vs. brachytherapy were more likely to experience urinary incontinence (23.8%, vs. 17.7%, p<0.001), urethral fistula (1.4% vs. 0.7% p=0.005), urinary retention(21.6%, vs. 8.6%, p<0.001) and erectile dysfunction [ED] (36.8% vs. 28.3%, Pp<0.001), but less likely to experience cystitis/hematuria (1.3% vs. 3.6%, p<0.001), rectal injury/ ulcer (1.7% vs. 2.9%, p=0.018), and rectal bleeding/proctitis (17.4% vs. 30.4%, p<0.001). Cryotherapy vs. brachytherapy urethral stricture rates (13.6% vs 14.4%, p=0.459) were similar. Additionally, men undergoing cryotherapy vs. brachytherapy were more likely undergo procedures for urinary retention (7.2%, vs. 3.2%, p<0.001) and ED (5.7% vs. 2.1%, p<0.001).
In adjusted analysis, cryotherapy vs. brachytherapy was associated with greater odds for urinary (OR 1.65; 95% CI:1.42-1.91) and erectile(OR,1.82; 95% CI: 1.59-2.1) complications. Baseline syndromes were associated with urinary (OR, 2.32; 95% CI: 2.11-2.55), bowel (OR, 2.46; 95% CI: 2.12-2.85) and erectile (OR, 4.64; 95% CI: 4.09-5.27) complications. Initial ADT (OR, 1.12; 95% CI: 1.03-1.21) and older age (≥70) (P <0 .001) were associated with urinary complications; higher Charlson score (>0) and older age (≥70) were associated with bowel complications (P <0 .001); black race (OR, 1.50; 95% CI: 1.29-1.74) was associated with erectile complication, respectively. Later year of treatment was associated with decreased rates of complications (P <0 .001).
Conclusion
While men undergoing cryotherapy vs. brachytherapy were more likely to experience urinary retention, incontinence, urethral fistulas, and ED, they were less likely to experience cystitis, rectal bleeding/proctitis and rectal injury/rectal ulcer.


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