Why do surgery or radiation treatments affect mens’ continence. The incontinence is due to injury or damage to sphincter muscles and other tissues that control the urine flows from the bladder to the penis. In many cases, the initial incontinence after treatment can decline in the year after treatment but as the survey results indicate full recovery is not always obtained.
Looking at incontinence, overall, 61% of the men surveyed said they lacked some urinary control (frequent dripping or no control) and 17% judged it to be a big or moderate problem. Those who have had a prostatectomy report less urinary control than those who have had radiotherapy or other treatments, and this results in a lower quality of life related to urinary symptoms. Comparing the surgery figure with active surveillance suggests that surgery doubles the rate of incontinence (see U2 below).
What does this mean for patients in practical terms? The survey asked men how many incontinence pads they use each day, and across all the survey respondents over a third use one or more pads a day. Of respondents who had had a prostatectomy, half were using pads. To put this into context, a 2017 study of men with roughly the same age profile who had NOT been treated for prostate cancer found that around 5% wear pads (PMID: 28168601). So there is clearly a significant effect here.
The first message is that active surveillance should be always be considered, if it can be applied safely, because overall it best protects quality of life. Certainly, in terms of incontinence and sexual function, the contrast between this and other approaches is clear.
The second take-home message is that early detection of prostate cancer is of the utmost importance. The more advanced the prostate cancer at diagnosis, the worse the effects of treatment on quality of life. The graph here shows that, looking at many factors together – discomfort, tiredness, insomnia and mental health – all of these are experienced more severely with treatments associated with more advanced prostate cancer.
And the third message we can take from all the data from the EUPROMS study is that high quality treatment and support are essential. The EUPROMS results show the severe effects that can come with treatment for prostate cancer. Men need all the expertise and experience they can get during treatment and after, with information and support at each stage of the journey. Every man with prostate cancer should be treated in a cancer centre with multidisciplinary teams.
Prostate Research and Treatments
What Effect Does Active Surveillance Have On A Patient’s Long Term Prospects
The goal of active surveillance is to avoid or delay the side effects of treatment in men with favourable-risk disease without compromising such long-term outcomes as survival or metastasis.
During active surveillance, prostate cancer is carefully monitored for signs of progression through regular prostate-specific antigen (PSA) screening, prostate exams, imaging and repeat biopsies. If symptoms develop, or if tests indicate the cancer is more aggressive, active treatment such as surgery or radiation may be indicated.
A North American study set out to assess the long-term outcomes of men on active surveillance for prostate cancer to determine which, if any, prognostic factors could predict the risk of metastases.
Most Patients With Local or Regional Prostate Cancer Die From Other Causes
Causes of death during prostate cancer (PCa) survivorship vary by patient and tumour characteristics, but among men with local or regional disease, non-PCa causes of death occur 4 times more frequently than death from PCa, investigators revealed at last week’s virtual meeting of the US Society of Urologic Oncology.
In the US SEER database 2000-2016, a total of 752,092 men had PCa, including 200,302 (27%) who died. Among men with local or regional disease, most deaths occurred within 5 to 10 years (38%) after diagnosis. The vast majority of these patients (83%) died from causes other than PCa, whereas only 17% died from PCa. Yet, according to standardised mortality ratios, patients with localised PCa were 23% less likely than the general population to die from most other causes. The most common noncancer causes of death were cardiac- and pulmonary-related.