Urinary incontinence and erectile dysfunction in patients with localized or locally advanced prostate cancer: A nationwide observational study.
BACKGROUND
Although urinary adverse events after treatment of prostate cancer (CaP) are common, population-based studies on functional outcomes are scarce. The aim of this study is to evaluate the occurrence of urinary incontinence (UI) and erectile dysfunction (ED) in daily clinical practice using a nationwide Dutch cohort of patients with localized or locally advanced CaP.


BASIC PROCEDURES
Patients were invited to complete the EPIC-26 questionnaire before treatment (baseline) and at 12 and 24 months after diagnosis. We calculated the mean EPIC-26 domain scores, stratified by treatment modality (i.e., radical prostatectomy, external radiotherapy, and no active treatment), and the proportions of patients with UI (defined as ≥ 2 pads per day) and ED (defined as erections not firm enough for sexual intercourse). Logistic regression modeling was used to explore the factors related to UI and ED after surgery.


MAIN FINDINGS
In total 1,759 patients participated in this study. Patients undergoing radical prostatectomy experienced clinically relevant worsening in the urinary incontinence domain. After excluding patients who reported UI at baseline, 15% of patients with prostatectomy reported UI 24 months after diagnosis. Only comorbidity was associated with UI in surgically treated patients. Regardless of treatment, patients reported a clinically significant reduced sexual functioning over time. Before treatment, 54% of patients reported ED. Among the 46% remaining patients, 87% of patients treated with radical prostatectomy reported ED 24 months after diagnosis, 41% after radiotherapy, and 46% in patients without active treatment. Bilateral nerve-sparing surgery was the only factor associated with ED after 24 months.


PRINCIPAL CONCLUSIONS
UI and ED frequently occur in patients with localized and locally advanced CaP, in particular after radical prostatectomy. The higher occurrence rate of UI and ED, compared with clinical trial participants, supports the importance of real-world data, which can be used for local treatment recommendations and patient information, but also to evaluate effects of future initiatives, such as treatment centralization and research aimed at improving functional outcomes.
['Vernooij|R W M|RWM|', 'Cremers|R G H M|RGHM|', 'Jansen|H|H|', 'Somford|D M|DM|', 'Kiemeney|L A|LA|', 'van Andel|G|G|', 'Wijsman|B P|BP|', 'Busstra|M B|MB|', 'van Moorselaar|R J A|RJA|', 'Wijnen|E M|EM|', 'Pos|F J|FJ|', 'Hulshof|M C C M|MCCM|', 'Hamberg|P|P|', 'van den Berkmortel|F|F|', 'Hulsbergen-van de Kaa|C A|CA|', 'van Leenders|G J L H|GJLH|', 'Fütterer|J J|JJ|', 'van Oort|I M|IM|', 'Aben|K K H|KKH|']
D000368:Aged D015331:Cohort Studies D007172:Erectile Dysfunction D006801:Humans D008297:Male D009367:Neoplasm Staging D009426:Netherlands D011183:Postoperative Complications D011468:Prostatectomy D011471:Prostatic Neoplasms D014549:Urinary Incontinence
Urinary incontinence Erectile dysfunction Prostate cancer Observational prospective study Patient reported outcome measures