Presentation Authors: Conner Brown*, Jared Winoker, Rollin Say, Richard Stock, Nelson Stone, New York, NY
Introduction: We sought to characterize patients with self-reported incontinence and self-reported pad use following permanent prostate brachytherapy (PPB).
Methods: We evaluated 2,277 men who underwent PPB +/- EBRT for localized prostate cancer. Primary outcomes were patient-reported incontinence (PRI) at last follow up visit, type of incontinence reported, and patient-reported pad use (PRP) at last follow up visit. The association of patient, disease, and treatment characteristics with PRI and PRP was assessed. Univariate analysis was performed using chi-squared, fisherâ€™s exact, studentâ€™s t-test, and ANOVA. Multivariate analysis was performed using binomial and multinomial logistic regression.
Results: Median follow up was 100 months. In total, 82 patients (3.6%) reported unresolved incontinence at last follow up, while only 17 reported using at least one pad. For patients reporting incontinence, 59 reported urge incontinence, 15 reported stress incontinence , and 8 reported mixed incontinence. Of the 17 patients using pads, 12 reported urge incontinence and 5 reported mixed incontinence, while none reported stress incontinence. In univariate analysis, the factors associated with increased PRI were post-treatment TURP (p=0.004), NCCN risk (p=0.058), EBRT (p=0.002), and baseline IPSS score (p=0.022). Increased PRP was associated with pre-treatment TURP (p=0.055), post-treatment TURP (p=0.008), NCCN risk (p=0.021), EBRT (p=0.01), and baseline IPSS score (p=0.049). On logistic regression, only post-treatment TURP (OR 6.55, p=0.001) was associated with PRI, while pre-treatment TURP (OR 4.82, p=0.020) and post-treatment TURP (OR 14.55, p=0.001) were associated with PRP. On multinomial logistic regression, diabetes (RRR=2.39, p=0.022) and EBRT (RRR=2.46, p=0.033) increased risk of urge incontinence, higher NCCN risk (RRR=5.42, 4.17, p=0.014, 0.068) and post-treatment TURP (RRR=10.37, p=0.005) increased risk of stress incontinence, and pre-treatment TURP (RRR=10.20, p=0.012) and post-treatment TURP (RRR=41.63, p < 0.001) increased risk of mixed incontinence.
Conclusions: Overall rates of incontinence following PPB are low, whether measuring PRI or PRP. However, there is discordance between these metrics. Pre- and post-treatment TURP remain the strongest factors associated with post-procedural incontinence, though history of diabetes and EBRT are associated with increased urge incontinence, and higher NCCN risk is associated with increased stress incontinence.