Purpose:
To evaluate international prostate symptom score and urinary quality of life in patients with prostate cancer who underwent low-dose-rate brachytherapy, and to identify lower urinary tract symptoms that must be improved to enhance post-operative urinary quality of life and factors associated with lower urinary tract symptoms.

Material and methods:
This study included 193 patients who underwent low-dose-rate brachytherapy alone (145 Gy). Importance–performance analysis was conducted to identify lower urinary tract symptoms that should be prioritized to improve urinary quality of life. Association between lower urinary tract symptom scores and each factor was investigated. Receiver operating characteristic curve analysis was used to evaluate dosimetric parameters related to lower urinary tract symptom score to predict an average score of ≥ 3. Cut-off values were determined.

Results:
One to nine months post-implantation was a period of significantly increased urinary quality of life scores compared with baseline (p < 0.05 each). The importance–performance analysis conducted for 1-9 months revealed that frequency, nocturia, and weak stream required improvement. Multivariate analysis showed that each lower urinary tract symptom score presented a significant association with its baseline value (p < 0.001 each, positive correlation). Frequency, incomplete emptying, urgency, and straining scores were significantly associated with prostate volume, whereas weak stream and intermittency scores were associated with dose covering 90% of the prostate and dose covering 90% of the urethra, respectively (p < 0.05 each, positive correlations). Cut-off values for these doses were 167.01 Gy and 136.84 Gy, respectively.

Conclusions:
This study highlights the importance of prioritizing specific lower urinary tract symptoms for improvement in post-operative urinary quality of life, and identifies the associated factors that can help in personalized treatment planning and goal-setting for better patient satisfaction.



中文翻译：

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应改善尿路症状以提高接受低剂量近距离放射治疗前列腺癌患者的术后泌尿生活质量：重要性-性能分析

目的：
评估接受低剂量近距离放射治疗的前列腺癌患者的国际前列腺症状评分和泌尿生活质量，并确定必须改善的下尿路症状以提高术后泌尿生活质量以及相关因素伴有下尿路症状。

材料和方法：
本研究纳入了 193 名仅接受低剂量近距离放射治疗 (145 Gy) 的患者。进行重要性-性能分析，以确定应优先考虑改善泌尿生活质量的下尿路症状。研究了下尿路症状评分与每个因素之间的关联。使用受试者工作特征曲线分析来评估与下尿路症状评分相关的剂量学参数，以预测平均评分≥3。确定临界值。

结果：
与基线相比，植入后 1 至 9 个月是泌尿生活质量评分显着提高的时期（各p < 0.05）。进行 1-9 个月的重要性-绩效分析表明，尿频、夜尿和尿流弱需要改进。多变量分析显示，每个下尿路症状评分与其基线值均呈显着相关（每个p < 0.001，正相关）。频率、不完全排空、尿急和用力评分与前列腺体积显着相关，而弱流和间歇评分分别与覆盖 90% 前列腺的剂量和覆盖 90% 尿道的剂量相关（各 p < 0.05，阳性）相关性）。这些剂量的截止值分别为 167.01 Gy 和 136.84 Gy。

结论：
本研究强调了优先考虑特定下尿路症状对于改善术后泌尿生活质量的重要性，并确定了有助于个性化治疗计划和目标设定以提高患者满意度的相关因素。