{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T08:08:50Z","timestamp":1788768530133,"version":"build-2803163510"},"reference-count":13,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2006,10,9]],"date-time":"2006-10-09T00:00:00Z","timestamp":1160352000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2006,10,9]],"date-time":"2006-10-09T00:00:00Z","timestamp":1160352000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2006,11]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To examine the relationship of \u2018symptom flare\u2019 with sexual function and lower urinary tract symptoms (LUTS) before brachytherapy, as we noted that after brachytherapy for prostate cancer, some patients had recurrent LUTS after an asymptomatic period; this secondary exacerbation of symptoms (\u2018symptom flare\u2019) occurred at \u22482\u2003years after implantation and was transient in most patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PATIENTS AND METHODS<\/jats:title>\n                    <jats:p>\n                      In all, 854 patients with organ\u2010confined prostate carcinoma had transrectal ultrasonography\u2010guided transperineal\n                      <jats:sup>125<\/jats:sup>\n                      I interstitial brachytherapy of the prostate gland between June 1991 and September 2002, and were considered candidates for this study. Detailed information on urinary function was self\u2010administered and prospectively collected before treatment and at intervals using the International Prostate Symptom Score (IPSS). Sexual function was evaluated with the Sexual Health Inventory for Men (SHIM), a five\u2010question, self\u2010administered diagnostic test that can help to indicate the presence or absence of erectile dysfunction (ED). We used previously established criteria to estimate the risk of prostate\u2010specific antigen (PSA) failure by dividing the men into three risk groups, i.e. low\u2010risk, with a PSA level of \u226410\u2003ng\/mL, stage \u2264T2a, Gleason \u22646; medium\u2010risk, with a PSA level of \u226415\u2003ng\/mL, Gleason 7 or stage T2b; and high\u2010risk, with a PSA level of &gt;15\u2003ng\/mL, stage &gt;T2b, or Gleason \u22658.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      There was a significant association of flare with ED; men with flare reported significantly more ED than men without (\n                      <jats:italic>P<\/jats:italic>\n                      \u2003=\u20030.020). Men with high\u2010risk disease reported more ED because they received more intensive treatment (hormones and increased radiation dose) than men with medium\u2010 or low\u2010risk disease. To correct for this confounding factor, multivariate linear regression was used; the regression was significant overall (\n                      <jats:italic>P<\/jats:italic>\n                      \u2003&lt;\u20030.001), and the effects of risk group (\n                      <jats:italic>P<\/jats:italic>\n                      \u2003&lt;\u20030.001) and flare (\n                      <jats:italic>P<\/jats:italic>\n                      \u2003&lt;\u20030.026) on SHIM score were significant and independent of each other. Flare was also significantly associated with a higher pre\u2010implant IPSS; the probability of flare was 62% for a pre\u2010implant IPSS of zero, to 94% for an IPSS of 30.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>\n                      Radiation reaction and radiation sensitivity contribute to ED and greater LUTS in men who have had brachytherapy for prostate cancer. This contribution is evident, e.g. in men with ataxia\u2010telangiectasia (ATM) gene mutations. Sequence variants in the ATM gene, particularly those that encode for an amino\u2010acid substitution, are associated with adverse radiotherapy responses among patients treated with\n                      <jats:sup>125<\/jats:sup>\n                      I prostate brachytherapy. Our finding of the association of urinary symptom flare with ED suggests it would be worthwhile to determine whether sildenafil is as effective in men with flare, and if not, whether higher sildenafil doses would be of value. Alternatively, \u03b1\n                      <jats:sub>1<\/jats:sub>\n                      \u2010selective adrenoceptor\u2010blocking agents, e.g. terazosin, combined with sildenafil, might be of benefit. Also, patients with a high IPSS before brachytherapy can be warned that they have a greater risk of flare and ED.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/j.1464-410x.2006.06398.x","type":"journal-article","created":{"date-parts":[[2006,10,9]],"date-time":"2006-10-09T04:37:31Z","timestamp":1160368651000},"page":"979-981","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Urinary symptom flare after brachytherapy for prostate cancer is associated with erectile dysfunction and more urinary symptoms before implantation"],"prefix":"10.1111","volume":"98","author":[{"given":"Steven","family":"Lehrer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Cesaretti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson N.","family":"Stone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard G.","family":"Stock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2006,10,9]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(03)00210-4"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1464-410X.2003.04430.x"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)36967-7"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0149-2918(01)80138-7"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(03)00627-8"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(95)00521-Y"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(00)00707-0"},{"key":"e_1_2_7_9_2","first-page":"25","volume-title":"SPSS Regression Models 13.0","author":"Anonymous.","year":"2004"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0302-2838(03)00358-0"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ijir.3901340"},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2003.08.015"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2004.09.031"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.ju.0000164286.47518.1e"}],"container-title":["BJU International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1464-410X.2006.06398.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1464-410X.2006.06398.x","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/j.1464-410X.2006.06398.x","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1464-410X.2006.06398.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T07:25:58Z","timestamp":1788765958000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/10.1111\/j.1464-410X.2006.06398.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,10,9]]},"references-count":13,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2006,11]]}},"alternative-id":["10.1111\/j.1464-410X.2006.06398.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1464-410x.2006.06398.x","archive":["Portico"],"relation":{},"ISSN":["1464-4096","1464-410X"],"issn-type":[{"value":"1464-4096","type":"print"},{"value":"1464-410X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,10,9]]},"assertion":[{"value":"2006-10-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}