Strategy for Incontinence From Prostate Cancer Surgery
Study Shows Benefits of Behavioral Therapy in Reducing Incontinence Episodes
David F. Pearson, MD, MPH, the director of the Center for Surgical Quality & Outcomes Research, and a professor of urologic surgery at Vanderbilt University Medical Center in Nashville, Tenn, says that behavioral therapy is as good as it gets when it comes to a nonsurgical way of treating incontinence after prostate cancer surgery, but he is not sure it is good enough for many men. Pearson wrote an editorial that accompanied the new study.
When it comes to the behavioral intervention outlined in the study, “there is no downside,” he says. “No harm, no foul.”
In terms of improvement, “the surgical options such as placement of sphincter or a male sling are better than this, but for a noninvasive treatment probably is at good as it gets,” he says.
“In the end, patients have to realize there is a chance of bothersome symptoms that will require another aggressive intervention down the road,” he says.
When a man is diagnosed with prostate cancer and considering surgery, it can be hard to appreciate how side effects such as incontinence can affect their quality of life, Pearson says.
“There is no denying the fact that this study shows it has an effect, but people just have to realize that if you want to be totally dry, this isn't going to do that,” he says.
“Are you OK going from four leaks a day to two? Most of my patients will say ‘No. When I walked in I didn’t wear diapers, and I don’t want to wear them now,’” he says.
“A lot of men are suffering from incontinence and there are those who will get treated with surgery to treat prostate cancer and will suffer from incontinence down the road who need a solution,” says Robert A. Smith, PhD, the director of Cancer Screening of the American Cancer Society based in Atlanta.
Behavioral therapy increases the list of options for these men, he says.
“In a small percentage of men, behavioral therapy eliminates incontinence entirely, but for most of them, it just reduces the number of events per week,” he says.
His advice? “If it did work, good, and if it didn’t work to your satisfaction, then you can consider surgery to treat the incontinence,” he says.