Adjuvant radiotherapy after prostatectomy ‘risks urinary incontinence’

Men who receive adjuvant radiation therapy following radical prostatectomy face a significantly increased risk of urinary incontinence in the following years, study findings indicate.

Writing in European Urology, the researchers say that the risk of urinary incontinence must be weighed against the oncological benefits of adjuvant radiotherapy when considering the management of these patients.

“Patients should be informed of such impairment before adjuvant treatments are planned,” say Nazareno Suardi and colleagues from the University Vita-Salute San Raffaele in Milan, Italy.

The researchers studied 361 radical prostatectomy patients with pT2 prostate cancer with positive surgical margins or pT3a/pT3b node-negative disease.

In all, 153 (42.2%) men received adjuvant radiotherapy, with the decision being made by the treating physician in discussion with the patient. Radiotherapy was typically delivered within 6 months of surgery and with a median dose of 70.2 Gy.

Men who received adjuvant radiotherapy tended to be older, have more advanced tumours and higher Gleason scores than those who did not. At a mean follow-up of 30 months’ post-surgery, 70.4% of the men had full urinary continence.

Rates of urinary continence recovery at 1 and 3 years were 51% and 59%, respectively, among men who received radiotherapy versus 81% and 87%, respectively, among men who did not. These differences were statistically significant.

Furthermore, after adjusting for baseline differences and other confounders, receipt of adjuvant radiotherapy was a significant independent risk factor for delayed recovery of urinary continence, with a hazard ratio of 0.57.

Thus, men who did not undergo adjuvant radiotherapy were 1.6 times more likely to be continent than those who did, after adjusting for all variables.

The only other factor that predicted the recovery of urinary continence was the adoption of a bilateral nerve-sparing approach, which was associated with a 2.33-fold increased likelihood of being continent. “We believe that these results are important due to the ongoing debate about the optimal treatment of locally advanced and positive surgical margins patients”, Suardi and co-authors write.

They conclude: “The delivery of [adjuvant radiation therapy] has a detrimental effect on UC [urinary continence] recovery itself as well as on time to UC recovery in patients treated with [radical prostatectomy].

“Therefore, the oncologic benefits of aRT must be balanced with an impaired UC recovery.”

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