A man's likelihood of needing a urinary incontinence procedure doubles within a 15-year period after radical prostatectomy treatment for prostate cancer, with significant risk linked to increasing patient age, radiation after treatment and low surgeon volume, report Sunnybrook researchers in the first, large, long-term study of rates of incontinence procedures among over 25,000 Canadian men.
"We hope these findings will help patients and their physicians have a more informed discussion about the treatment decision and potential implications for long term impact on quality of life," says Dr. Robert Nam, lead investigator, urological oncologist, and head of the Genitourinary Cancer Care team at Sunnybrook's Odette Cancer Centre.
Published in the Journal of Urology, the study included 25,346 Canadian men who underwent radical prostatectomy for prostate cancer from 1993 to 2006. The researchers used hospital and cancer registry data to identify men who were later treated with surgical procedures for urinary incontinence.
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Findings show the cumulative rate of post-prostatectomy incontinence surgery doubled from 2.8 percent at 5 years, to 4.8 percent at 15 years.
Factors predicting risk for incontinence surgery:
- patient age at the time of radical prostatectomy:
- 24 percent higher risk every decade for incontinence surgery (hazard ratio of 1.24), after age 62.2 years, the median age at time of prostate cancer surgery for the study cohort
- undergoing radiation treatment after radical prostatectomy:
- risk for incontinence surgery is 61 percent (hazard ratio of 1.61)
- increasing comorbidities (the presence of co-existing disease)
- (hazard ratio per increase in aggregated disease groups sum 1.06)
- level of surgeon experience:
- greater surgeon experience (49 or more radical prostatectomies performed annually) was negatively associated or had a lower risk with a hazard ratio of 0.59.
"Our findings also prompt much-needed dialogue among healthcare professionals about how we can further facilitate reduced complications for patients while continuing to have system resources to remedy in a timely manner, complications that do occur," says Dr. Nam, associate professor, Department of Surgery, University of Toronto, and associate scientist, Sunnybrook Research Institute.