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Radical removal of the prostate leads to permanent urinary leakage (incontinence) in a significant percentage of patients. This again emerges from a subgroup analysis of the large-scale ProtecT study published in 2020 in the renowned journal European Urology.
For this purpose, scientists from the University of Oxford and Bristol studied more than 2,500 patients with localized prostate cancer who either received radical removal of the prostate (prostatectomy) or radiotherapy -including brachytherapy (internal radiation)- or were actively monitored in a close-meshed surveillance (active surveillance). The men were then followed up over a 10-year period. During this time, the scientists recorded possible side effects of the therapy at specific intervals using standardized questionnaires.
The results of the subgroup analysis showed that patients after prostate surgery suffered the most. Prostate removal had the most severe impact on men's ability to hold urine: For example, one-fifth of patients whose prostates were surgically removed were still dependent on templates after three years, and this did not change in the subsequent three years. Patients who received external radiation therapy or brachytherapy (internal radiation), on the other hand, hardly suffered any loss of urinary continence compared to the control group (active surveillance).
"Due to the highly precise irradiation of the prostate in the course of brachytherapy, the urinary incontinence rate of patients remains at a very low level even years after the end of treatment," Dr. Pedram Derakhshani, urologist at the West German Prostate Center, confirms the current results. In this procedure, tiny radiation sources (seeds) are introduced directly into the tumor. The seeds remain there for several months and deliver high doses of radiation specifically to the tumor tissue. This has the advantage that the tumor is destroyed without damaging surrounding healthy tissue such as the urinary bladder, colon or sphincter muscle.
"Losses in quality of life as a result of surgery are all the more serious because many men with prostate cancer still undergo unnecessary surgery," Dr. Derakhshani sums up. The loss of the ability to hold urine is one of the problems that patients with prostate cancer fear most after treatment. This makes it all the more important to provide patients with comprehensive information in advance about the side effects of the various treatment options, says the Cologne urologist.
Neal DE, Metcalfe C, Donovan JL et al: Ten-year Mortality, Disease Progression, and Treatment-related Side Effects in Men with Localised Prostate Cancer from the ProtecT Randomised Controlled Trial According to Treatment Received. Eur Urol. 2020 Mar;77(3):320-330.