UI Surgery Rates Rise Years After RP: An Interview with Robert K. Nam, MD, MSc
Long-term quality of life for men who have undergone radical prostatectomy (RP) is inextricably tied to urinary incontinence (UI) issues.
Robert K. Nam, MD, MSc, and colleagues helped to shed light on the impact of this side effect by studying rates of UI-corrective surgery occurring up to 15 years following radical prostatectomy. Dr. Nam, the head of genitourinary cancer care and associate scientist at Sunnybrook Health Sciences Centre in Toronto, discusses the biggest eye-openers for him among his team's results, which were published in The Journal of Urology (2012;188:502-506).
YOU AND YOUR COLLEAGUES DISCOVERED THAT 5% OF RP PATIENTS ARE EXPECTED TO UNDERGO SURGERY FOR UI WITHIN 15 YEARS POSTOPERATIVELY.
Dr. Nam: Correct.
DID THIS SURPRISE YOU?
Dr. Nam: Yes and no. Yes, in that we were surprised the rate of UI surgery almost doubled from 2.6% at five years to 4.8% at 15 years. I thought the rate would be constant over the years.
But the observation that the rate went up actually is not surprising, if you think about it further. It just goes to the issue of cancer survivorship and that as patients live longer from their cancer treatment, they will be subjected to the normal diseases of aging. As they age and develop overactive bladder, their ability to handle these conditions is reduced because they've had prostate surgery.
DID YOU EVALUATE DIFFERENT AGE GROUPS?
Dr. Nam: Age was definitely a factor. The older you were, the more likely you were going to get a urinary-sphincter procedure. And that was shown in our study as well.
WHAT DO YOU THINK MIGHT OR SHOULD CHANGE IN THE WAY MEN ARE COUNSELED ABOUT THIS SIDE EFFECT?
Dr. Nam: Our findings provide more information for men to make a better informed decision as to whether prostate surgery is right for them. It also demonstrates that it's the younger patients who will benefit from surgery the most in terms of the side-effect profile, so it indicates that maybe older patients shouldn't go for surgery as much as younger patients should.
WHAT DO YOU THINK CAN OR SHOULD BE DONE TO LOWER THE LONG-TERM RATE OF UI SURGERY FOR MEN BEING TREATED FOR PROSTATE CANCER?
Dr. Nam: There are host factors that you can't change, such as patient age and level of comorbidity. And you can't really control whether a patient will need radiation therapy; that is disease-dependent.
What you can control, though, is surgeon volume, which was the most striking finding from the study. Surgeons who had the highest volume of radical prostatectomies per year—that was 49 or more in our study—had the lowest rates of patients requiring sphincter surgery. The rates of urinary sphincter surgery were half of those surgeons who had the lowest volume of radical prostatecotmies.