Complications after prostate brachytherapy in the medicare population

Objectives. Prostate brachytherapy is gaining in popularity among patients and physicians for the treatment of clinically localized prostate cancer. Although several major centers have published their results and morbidity data, nationwide data concerning complications have not been available. This study reports complications after prostate brachytherapy for men in the Medicare population. Methods. All men in the Medicare population who underwent prostate brachytherapy in 1991 were identified. All inpatient, outpatient, and physician (Part B) Medicare claims for these men from 1991 to 1993 were then analyzed to determine outcomes. Results. In 1991, 2124 men in the Medicare population underwent prostate brachytherapy. A total of 176 men (8.3%) underwent a surgical procedure for bladder outlet obstruction during the follow-up period, including transurethral resection of the prostate in 141 men. Seven men (0.3%) underwent a colostomy for complications secondary to radiation, and 4 men (0.2%) had an artificial urinary sphincter placed after prostate brachytherapy. Penile prostheses were placed in 14 men (0.6%) in the first 24 to 36 months after prostate brachytherapy. A diagnosis of urinary incontinence was carried by 140 men (6.6%) after the procedure; 179 men (8.4%) carried a diagnosis of erectile dysfunction after their procedure. A diagnosis consistent with rectal injury secondary to radiation appeared in 116 men (5.5%) after prostate brachytherapy. Conclusions. Prostate brachytherapy is being promoted as an effective treatment option for clinically localized prostate cancer that offers a low risk of complications. The low rate of urinary incontinence, bladder outlet obstruction, and erectile dysfunction was confirmed by analyzing a nationwide cohort of men. Rectal complications were also consistent with those described in published studies. The limitations of claim information in determining patient outcomes, however, must he kept in mind when evaluating these data. (C) 2000, Elsevier Science Inc.