1 in 20 RP patients need further surgery for incontinence within 15 years

A study just published in the Journal of Urology has suggested that (at least among patients in Ontario, Canada) one in every 20 men who undergo radical prostatectomy (RP) for treatment of localized prostate cancer will — within the following 15 years — require subsequent placement of an artificial urinary sphincter or a urinary sling.

Nam et al. conducted a population based study  based on > 25,000 men who were given an RP for prostate cancer in Ontario, Canada between 1993 and 2006. The authors were then able to use data from individual hospitals and cancer registries to identify men in this cohort who needed later, surgical treatment for urinary incontinence. The article is also discussed in a report on the Reuters.com web site.

The basic results of this study are as follows:

  • 25,346 men were given an RP for prostate cancer in Ontario within the 13-year time period specified.
  • Within a median orf 2.9 years post-RP
    • 703/25,346 patients (2.8 percent) were given an artificial urinary sphincter.
    • 282/25,346 patients (1.1 percent) underwent urethral sling placement.
  • The probability of an artificial urinary sphincter/sling procedure increased with time from RP.
  • The cumulative rates of an artificial urinary sphincter/sling procedure were
    •  2.6 percent within 5 years post-RP
    • 3.8 percent within 10 years post-RP
    • 4.8 percent within 15 years post-RP
  • Factors predicting surgery for incontinence were
    • Patient age at radical prostatectomy (hazard ratio [HR] = 1.24 per decade, p = 0.0002)
    • Radiotherapy after surgery (HR = 1.61, p <0.0001)
    • Surgeon volume  of 49 or more prostatectomies per year) (HR = 0.59, p <0.0001).

There is a clear message here that older men, men who need adjuvant or salvage radiation post-surgery, and men treated by surgeons with a relatively low annual prostatectomy volume are at significantly increased risk for post-surgical incontinence that needs serious surgical treatment, but it may be fair to assume that these same men are simply at higher risk for any degree of post-surgical incontinence.

One Response

  1. Though it took me closer to 20 years, it looks like I may be among the 1 in 20 soon.

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