BERKELEY, CA (UroToday.com) - We recently published data that suggests there is a substantially greater burden of urinary bother and incontinence among elderly prostate cancer survivors than previously observed.[1] These survivors had a two- to nearly five-fold prevalence of urinary incontinence compared to their peers without cancer, and this prevalence rose with increasing time since diagnosis. Survivors treated with observation, surgery, or androgen deprivation experienced significantly increased urinary bother by AUA Symptom Score Index when compared to men without cancer. In contrast with prior studies, our analysis combined long-term follow up with comprehensive assessments of observation, androgen deprivation, surgery, and radiation groups.
Historically, much of the quality-of-life literature focused on prostate cancer treatment was limited by relatively short follow-up periods (commonly 2 to 3 years). Our study was a cross-sectional analysis of nearly 6 000 community-dwelling men age 65 and older, of which 706 men reported a history of prostate cancer, with a mean time since diagnosis of 6.3 years. The relatively longer follow-up period allowed us to more effectively evaluate effects of time since treatment on urinary health when compared to longitudinal studies with shorter follow up.
We found that urinary leakage occurred much more frequently in men for whom at least 10 years had elapsed since their initial diagnosis of prostate cancer, and that the probability of leakage increased with time since diagnosis, independent of age at diagnosis. Although it may be difficult to perform long-term observational studies in the elderly prostate cancer population secondary to attrition, a recently published study of prostate cancer survivors, followed for 15 years after surgery or radiation, demonstrated similar decreases in urinary function over time.[2] These observations emphasize the need to better understand survivorship issues in elderly prostate cancer survivors.
Our analysis uncovered other findings worth noting. Urinary bother and incontinence were quite common in this elderly population, and even more common among men with prostate cancer on observation. Among men without cancer, only 68% were satisfied with their urination; among men with cancer on observation, only 48% were satisfied. Similarly, the percentage of men who reported leaking “not at all” was only 59% and 45% among men without prostate cancer and men with prostate cancer on observation, respectively.
These findings underscore the chronic burdens of prostate cancer diagnosis and treatment in an aging population that is already at risk for substantial urinary symptoms. The significant functional decrements seen in prostate cancer survivors on observation should heighten our awareness that a diagnosis of prostate cancer, even if managed by active surveillance or watchful waiting, might have a significant detrimental impact on urinary health. Future longitudinal analyses may further elucidate the impact of prostate cancer diagnosis and treatment in the aging male population.
References:
- Kopp RP, Marshall LM, Wang PY, Bauer DC, Barrett-Connor E and Parsons JK: The Burden of Urinary Incontinence and Urinary Bother Among Elderly Prostate Cancer Survivors. Eur Urol. 2013 Apr 3.
- Resnick MJ and Penson DF: Functional outcomes after treatment for prostate cancer. N Engl J Med. 368: 1654, 2013.
Written by:
Ryan P. Kopp, MDa and J. K. Parsons, MD, MHSb as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
aMemorial Sloan-Kettering Cancer Center, Department of Surgery, Urology Service, New York, NY
bUniversity of California San Diego, Department of Urology, San Diego, CA
The burden of urinary incontinence and urinary bother among elderly prostate cancer survivors - Abstract
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