Primary prostate cancer treatment improves urinary symptoms in men with pre-treatment urinary complications

The authors aimed to determine the benefits and drawbacks of prostate cancer treatment in patients who suffer from pre-treatment urinary problems. The authors concluded that patients with pre-treatment urinary problems benefitted from prostate surgery. 

Prostate surgery involves surgically removing the prostate gland. Radiotherapy is another form of cancer treatment that kills the cancer cells using radiation. There are numerous types of radiotherapy. External beam radiation (EBRT) therapy focuses single or multiple beams of radiation at the cancer site from an external source. Brachytherapy (BT) involves inserting a small seed of radiation into the cancer site.

In localized prostate cancer (cancer contained within the prostate gland) urinary problems are common. This can include incontinence (loss of control over the bladder), bladder irritation and urinary infections. There has been little research conducted on the benefits of surgery and radiation in men who suffer from urinary problems before treatment. 

The aim of this study was to determine whether treatment relieved urinary problems in men with who suffer from urinary problems before treatment.

1,021 patients were analyzed in this study, with a 2-year follow up period. 522 patients underwent surgery. 239 patients underwent EBRT. 260 patients underwent BT. 37% of patients experienced moderate to severe urinary problems before treatment.

Surgery patients experienced a significant increase in incontinence. These patients also experienced a significant decrease in urinary irritation/obstruction. Patients with urinary irritation/obstruction who underwent RP had 4.3 times the odds of symptom improvement. BT patients experienced a significant increase in both incontinence and urinary irritation. 

15% of surgery patients used medication for urinary problems before treatment. 6% of surgery patients used medication 2-years after treatment. Medication use did not change for patients undergoing EBRT (22% before treatment, 26% 2 years after treatment). 19% of BT patients used mediation for urinary problems before treatment, and 46% used medication 2 years after.

Medication use before treatment and patients who had moderate urinary problems before treatment were associated with relief from urinary problems after treatment. 

The authors concluded that men with pre-treatment urinary irritation/obstruction experienced a benefit rather than harm in overall urinary outcome following primary treatment. However, they suggest that all urinary symptoms be taken into account before deciding on treatment.