title: The burden of urinary incontinence and urinary bother among elderly prostate cancer survivors.
abstract: BACKGROUND
  Data describing urinary health in elderly, community-dwelling prostate cancer (PCa) survivors are limited.
  
  
  OBJECTIVE
  To elucidate the prevalence of lower urinary tract symptoms, urinary bother, and incontinence in elderly PCa survivors compared with peers without PCa.
  
  
  METHODS
  A cross-sectional analysis of 5990 participants in the Osteoporotic Fractures in Men Research Group, a cohort study of community-dwelling men ≥ 65 yr.
  
  
  METHODS
  We characterized urinary health using self-reported urinary incontinence and the American Urological Association Symptom Index (AUA-SI). We compared urinary health measures according to type of PCa treatment in men with PCa and men without PCa using multivariate log-binomial regression to generate prevalence ratios (PRs).
  
  
  CONCLUSIONS
  At baseline, 706 men (12%) reported a history of PCa, with a mean time since diagnosis of 6.3 yr. Of these men, 426 (60%) reported urinary incontinence. In adjusted analyses, observation (PR: 2.11; 95% confidence interval [CI], 1.22-3.65; p=0.007), surgery (PR: 4.41; 95% CI, 3.79-5.13; p<0.0001), radiation therapy (PR: 1.49; 95% CI, 1.06-2.08; p=0.02), and androgen-deprivation therapy (ADT) (PR: 2.02; 95% CI, 1.31-3.13; p=0.002) were each associated with daily incontinence. Daily incontinence risk increased with time since diagnosis independently of age. Observation (PR: 1.33; 95% CI, 1.00-1.78; p=0.05), surgery (PR: 1.25; 95% CI, 1.10-1.42; p=0.0008), and ADT (PR: 1.50; 95% CI, 1.26-1.79; p<0.0001) were associated with increased AUA-SI bother scores. Cancer stage and use of adjuvant or salvage therapies were not available for analysis.
  
  
  CONCLUSIONS
  Compared with their peers without PCa, elderly PCa survivors had a two-fold to five-fold greater prevalence of urinary incontinence, which rose with increasing survivorship duration. Observation, surgery, and ADT were each associated with increased urinary bother. These data suggest a substantially greater burden of urinary health problems among elderly PCa survivors than previously recognized.
authors.affiliation: Division of Urologic Oncology, UC San Diego Moores Cancer Center, University of California, San Diego, La Jolla, CA 92093-0987, USA. k0parsons@ucsd.edu
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Kopp
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Marshall
authors.forename: Patty Y
authors.initials: PY
authors.lastname: Wang
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Bauer
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barrett-Connor
authors.forename: J Kellogg
authors.initials: JK
authors.lastname: Parsons
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000009:adverse effects*; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000628:therapy*; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014549:Urinary Incontinence / Q000175:diagnosis / Q000453:epidemiology*
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal
keywords: Aging male; Elderly; Epidemiology; Incontinence; Lower urinary tract symptoms; Prostate cancer; Prostate cancer treatment; Urinary bother