Although there are well reported rates of post treatment incontinence, these are often from single surgeons or centers, which can biased. In addition, with varying definitions of incontinence used in the literature, it is possible that incontinence rates are underreported and not truly patient-centered outcomes.
The NHANES database was used to identify men that received treatment for prostate cancer in the form of either surgery, radiotherapy or combined therapy. The reported urinary incontinence was compared to a control group of men 60-80 years of age without prostate cancer. There were surprisingly high rates of urinary incontinence reported with the highest rates seen in men receiving combined therapy (82.7%). Those men receiving prostatectomy had higher rates of incontinence than men receiving radiation alone (57.4% vs 42.6%). There was no difference in rates of urge incontinence, but stress incontinence was again greater in men receiving surgery compared to radiation (50.9% vs 18.1%). These differences remained after controlling for additional factors known to be associated with incontinence.
We understand that there may be an element of over reporting in an analysis such as this as the questions from the NHANES survey may allow for some room for interpretation. However, it is also possible that patients may underestimate or underreport their quality of life bothers to their treating physician given their cancer survivorship. Nevertheless, analyzing patient reported outcomes in an informal and anonymous way may reflect a more accurate representation of disease burden. It certainly calls in to question that perhaps incontinence following prostate cancer treatment is a bigger concern than previously thought.
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Written By: Michael Daugherty, MD