Post-Prostatectomy Incontinence: Is There A Better Option?

The odds aren't in my favor or yours, for that matter, if you have both an X and a Y chromosome.  In fact, we have a 1 in 6 lifetime chance of being diagnosed with prostate cancer.  But what does that really mean?  As I've mentioned previously, we're more likely to die with prostate cancer than from it.  On the other hand, who wants to go around knowing that they have a cancer in their body and then not really doing anything about?  Even if it's a localized tumor.  Perhaps, especially if it's a localized tumor, we're more likely to say, "Phew! Glad I caught it early and took care of it since you never can tell when it might spread." 

But that's where current studies are demonstrating the error of our thinking.  The downsides to treatment are tremendous.  From radiation, there's colitis & cystitis.  From androgen deprivation therapy, there's obesity, diabetes, cardiovascular disease, and increased mortality.  From radical prostatectomy, there's the obvious immediate surgical complications as well as post-prostatectomy incontinence and erectile dysfunction.  In fact, 2 out of 3 men continue to experience incontinence 5 years after surgery, regardless of the new techniques & technologies available, eg nerve-sparing robot assisted surgery.

In a study just published looking at 208 community-dwelling men 51-84yo w/post-prostatectomy incontinence, the addition of in-office biofeedback and home pelvic floor electrical stimulation to 8 weeks of behavioral therapy (pelvic floor exercises and bladder control strategies) did not improve incontinence any better than behavioral therapy alone compared to placebo/delayed treatment serving as control.  Granted, behavioral therapy alone resulted in a 50% reduction in incontinence, but that also implies that half the patients continued to suffer.

However, what I found quite intriguing was the editorial written by an academic urologist who opined that a better way would involve active surveillance (thereby avoiding the risk of incontinence) since 23-42% of patients diagnosed w/prostate cancer will die with it rather than from it and therefore are exposed to risks & side effects w/o additional benefit.  In other words, if you're diagnosed with a low risk cancer, why increase the risk of urinary incontinence (and most likely erectile dysfunction) if you don't have to?  Instead, consider active surveillance whereby you closely monitor your PSA on a regular basis, re-biopsy as deemed necessary, and consider more aggressive interventions only if the cancer turns moderate to high risk (as denoted by your Gleason score increasing above a specific mark).  The bigger question is whether you can handle the wait.