PROSTATE CANCER AND URINARY INCONTINENCE

Abstract

INTRODUCTION AND OBJECTIVES: Urinary incontinence (UI) following prostate cancer (PCa) is common, and may vary depending on type of PCa treatment. Our objectives were to determine the proportion of UI occurring in men diagnosed with PCa, and to determine if type of PCa treatment was associated with UI. We examined these questions using data from the Olmsted County Study of Urinary Symptoms and Health Status among Men. METHODS: In 1990, a randomly selected cohort of white men, ages 40-79 years, from Olmsted County, Minnesota was assembled (55% participation; n=2447). Men were followed via biennial questionnaires through 2007. UI was classified as answering yes to questions on urinary leakage, use of bladder control items, diagnosis of incontinence, involuntary loss of urine, and/or a history of chronic UI. Community medical records were also reviewed to determine onset of biopsy-confirmed PCa and type of initial treatment for PCa. The proportion of PCa patients who reported incontinence was calculated for first and last follow-up following PCa diagnosis. Odds ratios (ORs) were calculated to assess the association between type of treatment (surgical vs non-surgical) and UI. Patients who had reported UI prior to their PCa diagnosis were excluded from the analyses. RESULTS: Overall, 225 (9%) men developed PCa, and 143 (64%) did not report UI prior to development of PCa and had questionnaire information available both preand post-cancer diagnosis. Of these men, 60 (42%) reported UI at the first follow-up after PCa diagnosis (median follow-up:1.0 years, interquartile range (IQR): 0.3, 1.6). At the last follow-up after PCa diagnosis, 51 (36%) reported UI (median followup: 6.1 years, IQR: 2.6, 9.4). Surgical treatment (n=77, 54%) was not significantly associated with UI at the first follow-up (age-adjusted OR: 1.2, 95% Confidence Interval (CI): 0.6, 2.7). However, surgical treatment was associated with UI after the last follow-up (age-adjusted OR: 2.5; 95% CI: 1.2, 5.3). CONCLUSIONS: These data indicate that urinary incontinence is indeed significant in patients after a diagnosis of PCa. Additionally, UI remains common even several years after PCa diagnosis, and is associated with surgical treatment. Appropriate management options therefore need to be actively discussed with these patients.