BY AMBER SMITH
When men are diagnosed with prostate cancer, their focus becomes treatment of the cancer. The complications of incontinence and erectile dysfunction are considerations, but the priority is usually survival.
Once the cancer is under control, these treatment side effects become more important to men. Urine leakage is a known complication risk for men whose prostate cancer is treated with surgery or radiation.
Incontinence can range from the occasional leakage of drops of urine to complete lack of urinary control. It’s a problem that can cause men to become isolated, for fear of social embarrassment. It can also lead to urinary tract infections, skin breakdown and wound infections.
A group of urologists at Upstate says the risk is higher than previously believed for a man who opts for the surgical removal of his prostate. Timothy Byler, MD, wrote about a survey of patients they conducted in the journal International Urology and Nephrology. His team included colleagues Gennady Bratslavsky, MD, Michael Daugherty, MD, and Raju Chelluri, MD.
Using a national database constructed by the Centers for Disease Control and Prevention, the National Health and Nutrition Examination Survey, Byler queried prostate cancer survivors about urinary incontinence. Men who participated in the survey were interviewed in their homes and then underwent standardized physical exams.
Fifty-seven percent of 136 men who underwent surgery for prostate cancer reported some urinary incontinence afterward. Interestingly, 23 percent of these men reported significant incontinence.
Regarding men who underwent radiation, 42 percent of 125 men experienced leakage, with 12 percent reporting significant leakage.
When men had both surgery and radiation treatments, leakage rates were as high as 80 percent.
Many doctors estimate patient incontinence risk between 10 to 20 percent. That’s based on an average from previous studies, most involving patients at just one center who reported incontinence after surgery as low as 6 percent and as high as 69 percent.
Byler’s data comes from patients who got care from various centers across the nation.
The Upstate urologists looked at both stress and urge incontinence. Stress incontinence is when urine leaks during physical activity. Urge incontinence is when urine leaks before a person can reach the toilet. Byler says both types of leakage may happen after prostate surgery, but stress incontinence is more common.
Removal of the prostate gland can weaken the sphincter muscle that allows for urinary leakage. For some men, incontinence is temporary, improving as they recover. Those who continue to struggle after recovery may seek treatment for leakage. Byler says a variety of remedies is available.
This article appears in the fall 2017 issue of Cancer Care magazine.