Risk for incontinence after radical surgery for localized prostate cancer

A new Swedish study has provided us with some interesting data on risk for significant incontinence after radical prostatectomy as a first-line treatment for localized disease.

Wallerstedt et al. wanted to be able to identify any specific factors that could be associated with significant levels of urinary incontinence at 12 months after the original surgery. To do this, they defined “significant incontinence” as the need to change a urinary pad once or more than once a day (i.e., the need to use at least two pads a day). Using validated, self-administered questionnaires in advance of surgery, at 3 months post-surgery, and at 12 months post-surgery, they then collected data from 1,529 men who had been given a radical prostatectomy at any one of 15 hospitals in Sweden between September 2008 and February 2010.

They analyzed the data they collected for information on 38 different factors that they thought might possibly be related to risk for significant incontinence.

Here is what they found:

  • 1,360/1,529 patients (89 percent) provided satisfactory prospective data from completion of the questionnaires at all three time points.
  • Age at time of surgery predicts long-term urinary incontinence on an exponential scale.
  • Patients who reported having urinary leakage before prostate cancer diagnosis had an age-adjusted relative risk of significant incontinence at 12 months post-surgery of 1.8.
  • There was no statistically significant correlation between post-surgical incontinence and
    • Prior transurethral resection of the prostate
    • High body mass index
    • Any of the other 34 factors evaluated.

This study appears to demonstrate with considerable clarity that only two factors significantly affect risk for urinary incontinence at 12 months post-surgery: the patient’s age and his level of continence pre-surgery.

Of course this does not mean that a bad surgeon cannot also affect your risk for post-surgical incontinence. The Swedish nationalized health system is built around the idea that specialists really do specialize, and that therefore the majority of radical prostatectomies carried out each year in Sweden are done by surgeons who have significant expertise in the conduct of this operation. For newly diagnosed patients in other countries, the messages seem very clear:

  • Make sure you find a high volume, high quality prostate cancer surgeon if you want to have surgery.
  • Think hard about whether surgery is really going to work well for you if you are older than about 65 or already have some degree of urinary incontinence.

3 Responses

  1. Would be nice to know what the 12-month rates and levels of incontinence were for different age groups. So far we’re just being told that age and pre-surgical continence issues were associated with unspecified increases in the 12-month incontinence rates from unspecified levels.

  2. Unfortunately I don’t have the full text of this paper. I only have access to the abstract at this time.

  3. We have now received the full text of this paper from one of the authors, and an additional post giving rates of incontinence and pad use at 12 months was posted to this site on December 10.

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