A major part of my practice is treating men with prostate cancer (PCa) who are experiencing stress urinary incontinence (SUI), urine leakage with effort, when laughing, coughing, exercising, etc. SUI following PCa surgery (robotic or open prostatectomy) is a complication seen in a subset of men.
Men are referred to me by colleagues from inside and outside my academic institution and many men find me when searching online. In addition to SUI, many of these men report sexual dysfunction. Most are within six months of post-surgery but I have many who present many years after surgery. So I thought I would share with you a fairly recent publication by Hoffman and colleagues which I found particularly informative and relevant.
This Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study was a prospective population-based study designed to identify outcomes (authors labeled these as “patient harm”) of PCa treatments. Men were categorized as noted in this table:
The study analyzed patient-reported functional outcomes through five years after starting treatment.
From 2011 to 2012, men with clinically localized PCa were recruited from the Surveillance, Epidemiology, and End Results (SEER) program registries and the Cancer of the Prostate Strategic Urologic Research Endeavor PCa observational registry. Men were asked to complete surveys at baseline, 6 months, 1-, 3-, and 5-years post-enrollment. Surveys included the Expanded Prostate Index Composite (EPIC) and the Medical Outcomes Study 36-Item Short-Form Survey (SF-36). A total of 2,005 men met inclusion criteria and completed the baseline and at least one post-baseline survey. The survey response rate was impressive: 97% at 6 months, 94% at 1 year, 85% at 3 years, and 77% at 5 years.
I recommend you read the entire article as there is a great deal of comparison outcome data between the two groups specific to treatments reported and there are also supplemental tables online. Of particular interest to me were the results of the EPIC survey’s specific domains for urinary incontinence and sexual function.
Prostatectomy was associated with clinically meaningful worse urinary incontinence than other management options through five years for men with both favorable- and unfavorable-risk PCa. Prostatectomy was associated with clinically meaningful worse sexual function over three years compared with active surveillance. Low dose brachytherapy was associated with worse urinary irritative voiding symptoms, sexual and bowel symptoms at one year compared with active surveillance. External beam radiation therapy (ERBT) was associated with urinary, sexual, and bowel function changes, not clinically different from active surveillance at any point through five years.
The conclusion of this large prospective study was that men with PCa undergoing current treatment options experience significant urinary and sexual problems that continue well past the initial post-treatment period.
Written by: Diane Newman, DNP, CRNP, FAAN, BCB-PMD, Nurse Practitioner (NP), Co-Director, Penn Center for Continence and Pelvic Health Director, Clinical Trials, Division of Urology, Adjunct Professor of Urology in Surgery, Penn Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
1. Hoffman, Karen E., David F. Penson, Zhiguo Zhao, Li-Ching Huang, Ralph Conwill, Aaron A. Laviana, Daniel D. Joyce et al. "Patient-reported outcomes through 5 years for active surveillance, surgery, brachytherapy, or external beam radiation with or without androgen deprivation therapy for localized prostate cancer." Jama 323, no. 2 (2020): 149-163.
Published Date: May 13th, 2020