The lowest IPSS following installation of the radioactive seeds (postimplant nadir) is taken as baseline. The IPSS ranges from 0 to 35, with a score >= 20 considered severe.
difference in the IPSS =
= (current IPSS) - (postimplant nadir IPSS)
A transient increase in the IPSS is termed the urinary symptom flare. A flare may be defined as an increase in the IPSS >= 5 points or >= 8 points.
During a flare the patient may develop:
(1) urinary retention
(2) urgency
(3) urge incontinence
A urinary symptom flare occurs in with some frequency, often 16 to 24 months after the implantation of the radioactive seeds. It may occur several years after the implantation.
Many patients have resolution of the symptoms within 6 months and most by 1 year.
Factors that have been associated with flares:
(1) not receiving androgen suppression therapy
(2) diabetes
(3) prostate edema
(4) RTOG urinary toxicity Grade 3 or 4
(5) RTOG rectal toxicity Grade 2 or higher
(6) higher IPSS prior to brachytherapy
Differential diagnosis:
(1) nontransient or progressive elevation of the IPSS
