Gross hematuria can occur in men up to several years after undergoing prostate brachytherapy, according to a study.

The condition is more likely to develop in men with larger prostates volumes (more than 40 cm3), those who also undergo external beam radiotherapy (EBRT), and those who are free from biochemical failure, researchers reported online ahead of print in BJU International.

Michael S. Leapman, MD, and collaborators at the Mount Sinai School of Medicine in New York reviewed hematuria outcomes in 2,454 patients who had transperineal prostate brachytherapy over a 20-year period. The study population had a median follow-up of 5.9 years.

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Of the 2,454 patients, 218 (8.9%) reported gross hematuria at a median time of 772.2 days after seed implantation.

Only 3.8% of men with PSA failure reported hematuria compared with 9.4% of those with biochemical control, the researchers noted. A possible explanation for this finding is that differences among patients may affect their response to radiation, with respect to both toxicity and disease control. Patients who are more sensitive to radiation may be more likely to have a favorable treatment response, but also experience increased mucosal injury or necrosis that leads to hematuria, Dr. Leapman’s group explained.

In addition, the authors noted that the median time to the first hematuria episode was more than two years, with 25% of patients reported hematuria more than five years after seed implantation. The delay could be the result of several factors, such as the protracted contribution of radiation-altered prostatic and bladder tissue with accumulated physiologic causes of hematuria observed with aging and prostatic growth that may require years to develop, the investigators explained.

The authors pointed out that the “significance of observed blood in urine after permanent brachytherapy remains unclear and warrants further study to understand the etiology and clinical course of this morbidity.”