Prostate cancer: post-irradiation incontinence

The experience of 272 patients with prostate cancer treated between 1976 and 1987 by external irradiation was reviewed to assess causal factors for post-irradiation incontinence and to determine measures to reduce the risk of this complication. No patient had incontinence before definitive irradiation or radical prostatectomy. Post-irradiation incontinence was observed in 19 of 272 patients (7%), including 14 with mild, 2 with moderate and 3 with severe disease. Incontinence after definitive irradiation was not significantly related to tumor stage or tumor control: 8 of 192 patients (4%) had local control and 2 of 33 (6%) had local failure. Incontinence was related to a urological operation performed in 1 of 105 patients (1%) who underwent needle biopsy and 7 of 130 (5.5%) who underwent transurethral prostatectomy before irradiation. Incontinence was more frequent, 2 of 6 patients (33%), and more severe in patients who underwent transurethral prostatectomy after irradiation. Of 31 patients 9 (29%) were incontinent after radical prostatectomy. No additional patient had incontinence after postoperative irradiation. However, 3 patients had a temporary increase in the severity of incontinence. The risk of post-irradiation incontinence may be decreased by more selective use of transurethral prostatectomy. Of 136 patients 26 (20%) underwent transurethral prostatectomy for tissue diagnosis. A needle biopsy would be the procedure of choice. A total of 29 patients with urinary outlet obstruction was treated without transurethral prostatectomy before irradiation. Ten patients with relatively mild urinary outlet obstruction were treated by irradiation alone, while 19 with more severe urinary outlet obstruction had endocrine therapy before irradiation and none of the 29 patients (0%) had post-irradiation incontinence.