Men with lower urinary tract symptoms (LUTS) who undergo prostate cancer (PCa) treatment, on balance, experience relief rather than worsening of symptoms, a new study finds.
“Practitioners should consider the full spectrum of urinary symptom burden evident before PCa treatment in treatment decisions,” Peter Chang, MD, MPH, of Beth Israel Deconess Medical Center in Boston, and colleagues concluded in The Journal of Urology.
For the prospective, multicenter study, the investigators compared urinary symptoms before and after radical prostatectomy (RP), external beam radiation therapy (EBRT), and brachytherapy (BT), in 1021 American men with T1 to T2 PCa from the Prostate Cancer Outcomes and Satisfaction with Treatment Assessment (PROST-QA) cohort. In addition to patient-reported urinary bother, the researchers novelly monitored changes in urinary medication usage (i.e., alpha-blockers, 5-alpha reductase inhibitors, and anticholinergics) and urinary procedure interventions. Most men undergoing RP had nerve-sparing procedures. A majority of EBRT patients had intensity-modulated radiation treatment, with a third also receiving neoadjuvant hormonal therapy. Men selecting BT received permanent, low-dose radioactive implants. Less than 5% of men overall had adjuvant or salvage hormonal therapy.
The investigators compared urinary symptom burden before and after treatment by patients’ response to the Expanded Prostate Cancer Index Composite (EPIC-26) question: How much of a problem has your urinary function been for you? Before PCa treatment, 37% of men reported moderate to severe LUTS. Incontinence was rare. Results showed urinary symptom burden improved for 23% and worsened for 28% following PCa treatment.
Rates of urinary medication usage before and 2 years after PCa treatment were 15% and 6%, respectively, for RP, 22% and 26% for EBRT, and 19% and 46% for BT. Urinary procedure rates did not differ significantly among treatment groups.
Using ordinal logistic regression analyses, the investigators identified pre-treatment urinary medication usage and pre-treatment moderate LUTS as favorable predictors of urinary symptom relief. Men with pre-existing LUTS who had RP experienced the greatest symptom relief, even after considering new urinary incontinence in some men. Previous research has suggested that some men find LUTS more bothersome than incontinence, the researchers noted.
“Our use of ordinal logistic regression allowed us to identify pre-treatment LUTS as a factor that should not be ignored when counseling patients on what to expect for their urination after treatment,” Dr Chang and his team remarked.
The investigators verified the magnitude of pre-treatment urinary symptom burden and the benefit of PCa treatment using data from a Spanish cohort of 539 patients from the Multicentric Spanish Group of Clinically Localized Prostate Cancer.