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Are we underestimating the rates of incontinence after prostate cancer treatment? Results from NHANES

  • Urology - Original Paper
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Abstract

Purpose

Local therapy for prostate cancer (PCa) includes radical prostatectomy (RP) and radiotherapy (XRT), both of which share a complication of urinary incontinence. Post-treatment incontinence has been reported to occur 6–69%, yet no truly patient-centered report has been compiled. We evaluated patient-reported incontinence rates and bother scores after treatment for prostate cancer.

Methods

The NHANES database was queried for all men who reported a diagnosis and treatment of PCa from 2001 to 2010. A control arm of men without a diagnosis of PCa age 60–80 years was constructed for baseline incontinence rates. Incontinence was patient-reported and obtained through questionnaires. Three additional cohorts were created for patients treated with RP, XRT or combination RP and XRT.

Results

We identified 316 men treated for prostate cancer, of which 136 reported RP and 125 reported XRT, who were compared to 3534 controls. Men that underwent RP experience significant incontinence rates of 23% compared to 12% of those patients treated with XRT, whereas those patients with combined therapy had incontinence rates of 52% (p < 0.0001). Bother scores did not significantly vary, but were increased compared to baseline. Urge incontinence did not differ between treatment groups, but stress incontinence was significantly higher in surgical patients.

Conclusion

These data from a nationwide sample of patient-reported urinary outcomes have limited interviewer bias and report significantly higher incontinence rates, which may impact prostate cancer discussions. This further underscores the importance of patient-reported outcomes in the evaluation of treatment success and counseling for patients with prostate cancer.

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Author information

Authors and Affiliations

  1. Department of Urology, Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA

    Michael Daugherty, Raju Chelluri, Gennady Bratslavsky & Timothy Byler

Authors
  1. Michael Daugherty
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  2. Raju Chelluri
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  3. Gennady Bratslavsky
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  4. Timothy Byler
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Contributions

MD, RC, GB and TB were involved in the project development, data collection, data analysis and manuscript writing

Corresponding author

Correspondence to Timothy Byler.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

NHANES is a publicly available database organized by the National Center for Health Statistics (NCHS) that is an ongoing cross-sectional study. The protocol for data gathering is approved by the NCHS institutional review board with written informed consent obtained from each patient as they are enrolled in the study.

Appendix 1: NHANES incontinence questions from the kidney conditions questionnaire

Appendix 1: NHANES incontinence questions from the kidney conditions questionnaire

How often have urinary leakage?

  1. 1.

    Never.

  2. 2.

    Less than once a month.

  3. 3.

    A few times a month.

  4. 4.

    A few times a week.

  5. 5.

    Every day and/or night.

How much does urine lose each time?

  1. 1.

    Drops.

  2. 2.

    Small splashes.

  3. 3.

    More.

Leak urine during physical activities?

  1. 1.

    Yes.

  2. 2.

    No.

How frequently does this occur?

  1. 1.

    Less than once a month.

  2. 2.

    A few times a month.

  3. 3.

    A few times a week.

  4. 4.

    Every day and/or night.

Urinated before reaching the toilet?

  1. 1.

    Yes.

  2. 2.

    No.

How frequently does this occur?

  1. 1.

    Less than once a month.

  2. 2.

    A few times a month.

  3. 3.

    A few times a week.

  4. 4.

    Every day and/or night.

Leak urine during non-physical activities?

  1. 1.

    Yes.

  2. 2.

    No.

How frequently does this occur?

  1. 1.

    Less than once a month.

  2. 2.

    A few times a month.

  3. 3.

    A few times a week.

  4. 4.

    Every day and/or night.

How much did urine leakage bother you?

  1. 1.

    Not at all.

  2. 2.

    Only a little.

  3. 3.

    Somewhat.

  4. 4.

    Very much.

  5. 5.

    Greatly.

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Daugherty, M., Chelluri, R., Bratslavsky, G. et al. Are we underestimating the rates of incontinence after prostate cancer treatment? Results from NHANES. Int Urol Nephrol 49, 1715–1721 (2017). https://doi.org/10.1007/s11255-017-1660-5

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  • DOI: https://doi.org/10.1007/s11255-017-1660-5

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