Prostate cancer is the most common cancer in men. Prostatectomy is the most common treatment. Morbidity from prostatectomy is high-80% of men experience urinary incontinence which negatively impacts the quality of life. Postsurgical pelvic floor muscle training is commonly prescribed but recent systematic reviews found no evidence of efficacy. We propose a new treatment that commences preoperatively and targets functional training of specific pelvic floor muscles that contribute to urinary continence. Assessment and biofeedback using transperineal ultrasound imaging assists in training. This will be compared against conventional training (maximal pelvic floor muscle contraction assessed by digital rectal examination) and no training. Embedded physiological studies will allow the investigation of moderation and mediation of the treatment effect on the outcomes.
This randomised clinical trial will include 363 men scheduled to undergo radical prostatectomy for prostate cancer. Participants will be randomised into urethral training, conventional training and no training groups. Clinical data will be collected at baseline (1-2 weeks presurgery) and postsurgery after catheter removal, weekly to 3 months (primary endpoint) and monthly to 12 months. Outcomes include 24-hour pad weight test (primary), incontinence, quality of life and cost-effectiveness data. Neuromuscular control measures of pelvic floor muscles will be measured at baseline, postsurgery, 6 weeks, 3 and 12 months. Study assessors and statisticians will be blinded to the group allocation.
This study is registered with the Australian New Zealand Clinical Trials Registry and has ethical approval from the university and host hospital ethics committees. Trial outcomes will be shared via national/international conference presentations and peer-reviewed journal publications.
BMJ open. 2019 May 05*** epublish ***
Paul Hodges, Ryan Stafford, Geoff D Coughlin, Jessica Kasza, James Ashton-Miller, Anne P Cameron, Luke Connelly, Leanne M Hall
School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia., Renal Medicine, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia., Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia., Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA., Centre for the Business and Economics of Health, University of Queensland, Brisbane, Queensland, Australia.