Long-term Continence Outcomes in Men Undergoing Radical Prostatectomy for Clinically Localized Prostate Cancer

Abstract

Background Urinary incontinence is a common short-term complication of radical prostatectomy (RP). Little is known about the long-term impact of RP on continence. Objective To elucidate the long-term progression of continence after RP. Design, setting, and participants From October 2000 through September 2012, 1788 men undergoing open RP for clinically localized prostate cancer by a single surgeon at an urban tertiary care center prospectively signed consent to be followed before RP and at 3, 6, 12, 24, 96, and 120 mo after RP. A consecutive sampling method was used and all men were included in this study. Intervention Men underwent open RP Outcome measurements and statistical analysis Regression models controlled for preoperative University of California, Los Angeles–Prostate Cancer Index urinary function score (UCLA-PCI-UFS), age, prostate-specific antigen level, Gleason score, stage, nerve-sparing status, race, and marital status were used to evaluate the association of time since RP with two dependent variables: UCLA-PCI-UFS and continence status. Results and limitation The mean UCLA-PCI-UFS declined between 2 yr and 8 yr (83.8 vs 81.8; p = 0.007) and marginally between 8 yr and 10 yr (81.8 vs 79.6; p = 0.036) after RP, whereas continence rate did not significantly change during these intervals. Men ≥60 yr old experienced a decline in mean UCLA-PCI-UFS between 2 yr and 8 yr (p = 0.002) and a marginal decline in continence rate between 2 yr and 10 yr (p = 0.047), whereas these variables did not change significantly in men <60 yr old. These outcomes are for an experienced surgeon, so caution should be exercised in generalizing these results. Conclusions Between 2 yr and 10 yr after RP, there were slight decreases in mean UCLA-PCIUFS and continence rates in this study. Men aged <60 yr had better long-term outcomes. These results provide realistic long-term continence expectations for men undergoing RP.

Long-term Health-related Quality of Life After Primary Treatment for Localized Prostate Cancer: Results from the CaPSURE Registry

“…A previous report suggested that men older than 60 yr experienced more accelerated declines in urinary function after RP compared to their younger counterparts, suggesting that age may be a driver of late declines in functional scores [15].…”

Psychosocial perspectives on sexual recovery after prostate cancer treatment

“…3 Along with residual urinary incontinence, ED is the most persistent and debilitating patient-reported adverse effect of prostate cancer treatment. 4,5 ED is associated with significant declines in quality of life and has negative effects on psychological and marital adjustment for both patients 2,6,7 and their partners. 2,[7][8][9][10][11][12] About half of all patients will try a treatment for ED at some point after undergoing prostate cancer treatment.…”

Male Stress Urinary Incontinence Following Surgical Intervention: Procedures, Technical Modifications, and Patient Considerations

“…Recently, maturation of datasets has allowed for evaluation of functional outcomes for even longer time frames. For RRP, 10-year outcomes in a longitudinal study using UCLA-PCI urinary function index has been shown to have declines in urinary function from 2 to 8 years and small but signifi cant declines from 8 to 10 years [ 61 ]. These changes may mirror normal changes in urinary function with aging, but have important implications for counseling patients to the expected recovery following surgery and may indicate that recovery of functional results may have a prolonged course that is frequently not captured in shorter-term studies.…”

“…These changes may mirror normal changes in urinary function with aging, but have important implications for counseling patients to the expected recovery following surgery and may indicate that recovery of functional results may have a prolonged course that is frequently not captured in shorter-term studies. Additionally these longer-term follow-up studies are of critical importance given that the average prostate cancer patient will survive 14 years following primary treatment of prostate cancer [ 61 ].…”