The effects of non-metastatic prostate cancer treatment on urinary functions

The authors aimed to determine the effect of radiation and surgery on urinary adverse effects in prostate cancer.

Prostate cancer is usually treated with surgery or radiation with high rates of long-term survival. Surgery can involve procedures such as a radical prostatectomy which involves removing the entire prostate. Radiation therapy involves the application of radiation beams to the site of the tumor. This can include external-beam radiation therapy (EBRT – an external radiation source focused towards the tumor site) or brachytherapy (radioactive seeds are placed internally at the tumor site).

In some cases urinary adverse events (problems that occur after treatment affecting the urinary tract) can occur after treatment. This can include urinary tract infections, cystitis (infection in the bladder), incontinence (involuntary urination) and urethral obstruction (blockage in the tubes that connect the kidney and bladder).

The aim of this study was to determine urinary adverse events experienced after surgery or radiation in prostate cancer.

322,472 patients were evaluated in this study. The average follow-up time was 4.7 years. Patients were separated into the following groups based on the treatment they received: EBRT alone, brachytherapy alone, radical prostatectomy alone, EBRT + brachytherapy, EBRT + radical prostatectomy and cryotherapy (using extremely cold temperatures to destroy cancer cells).

Urinary adverse events were highest in the radical prostatectomy + EBRT group at 36.4% after 10 years. 27.2% of patients in the radical prostatectomy group experienced adverse urinary events after 10 years, with the majority occurring within the first year. This was similar to the brachytherapy + EBRT group with 27.4% of patients experiencing adverse urinary events. 20% of patients who received brachytherapy alone and 17% of patients receiving EBRT alone experienced adverse urinary events compared to the control group (patients who did not receive these treatments), of whom 17% had adverse urinary events.

Patients who received radical prostatectomy alone or in combination with EBRT had the highest occurrence of incontinence. Patients receiving a combination of both treatments were more than three times at risk of experiencing any urinary adverse event  and were the most likely to experience the most common adverse event, bladder outlet obstruction (prevents urination). 

Patients who received EBRT alone had the lowest risk of experiencing an adverse event following treatment. However, EBRT patients who reported a bladder outlet obstruction at the start of the study had the highest risk of experiencing an adverse event after treatment in comparison to patients who did not.

The authors conclude that patients who receive radical prostatectomy, radical prostatectomy +EBRT or brachytherapy + EBRT are at an increased risk of experiencing urinary adverse events.

The study population was based on adverse events in elderly men with short follow-up times so the risk cannot be applied to all patients receiving these treatments.

If you have concerns about the problems that may occur after radical prostatectomy, EBRT or brachytherapy please consult your doctor.