TUESDAY, Jan. 11 (HealthDay News) -- Nearly two-thirds of men
who have prostate cancer surgery experience urinary incontinence
afterward, but new research suggests that behavioral therapy can
help lessen bladder control problems for a significant number of
After eight weeks of behavioral therapy -- including fluid
management, pelvic exercises and bladder control techniques -- the
researchers found a 55 percent reduction in incontinence
"Behavioral therapy is one more option for men," said study author Dr. Patricia S. Good, a professor of geriatric medicine at the University of Alabama at Birmingham. "It's not a perfect treatment, and it does require work, but it also provides a significant improvement in quality of life."
The findings are reported in the Jan. 12 issue of the
Journal of the American Medical Association.
Over a lifetime, about one in six men will be diagnosed with
prostate cancer. One treatment option, called a radical
prostatectomy, includes removing the prostate gland and surrounding
tissue as well as the seminal vesicles, according to the U.S.
National Cancer Institute. And, though the surgery has been proven
effective for removing the cancer, it can cause serious side
effects, including long-lasting urinary incontinence in as many as
65 percent of the men who undergo the surgery, according to the
An additional surgical intervention is available to help with
urinary incontinence, but many men who've already gone through
cancer surgery are reluctant to have another surgical procedure,
they point out.
Other options that might help with incontinence include
behavioral therapy, biofeedback and pelvic floor electrical
stimulation. To see which of these alternatives might be helpful,
Goode and her colleagues recruited a group of 208 men, 51 to 84
years old, who were experiencing urinary incontinence a year or
more after having had prostate cancer surgery.
The men were randomly assigned to one of three groups. One group
participated in eight weeks of behavioral therapy, another group
had behavioral therapy plus biofeedback and pelvic floor electrical
stimulation and the third group was given no additional treatment
and served as the control group. The men were asked to keep bladder
diaries throughout the study.
Behavioral therapy, which included four home visits, about one
every two weeks, involved instruction in pelvic floor exercises,
pelvic muscle contraction and daily exercises, such as deliberately
stopping the flow of urine. they also practiced urge control, which
meant delaying a visit to the toilet and using pelvic floor
contractions to avoid an accident. Men in this group were
instructed to drink eight ounces of beverages six to eight times a
day, spaced throughout the day. They were advised to avoid
The second group received this training and, in addition, was
given in-office biofeedback training and daily at-home pelvic floor
electrical stimulation, according to the study.
After eight weeks, the researchers found that the average number
of incontinence episodes dropped from 28 to 13 a week, a 55 percent
decline, for the men in the behavioral therapy group, and from 26
to 12 episodes a week, down 51 percent, for men who'd had
biofeedback and electrical stimulation as well as behavioral
therapy. The control group had a 24 percent reduction, on average,
in incontinence episodes.
The reductions in incontinence lasted at least 12 months, the
"We were very pleased," Goode said. "And, the men who decreased their accidents by half were thrilled."
Not everyone is convinced, however, that behavioral therapy is
the best option.
"For patients with incontinence, especially bad incontinence, behavioral therapy might not be worth the time," said Dr. David Penson, professor of urological surgery and director of surgical quality and outcomes at Vanderbilt University in Nashville, Tenn. "I don't think the bang is worth the buck."
"For men with a little bit of post-prostatectomy incontinence, behavioral therapy isn't a bad option if you're averse to having another surgery," said Penson, who authored an editorial on the study in the same issue of the journal. "Behavioral therapy works, but don't expect too much."
For many men, he added, an even better option might be to wait
to have surgery and monitor this often slow-growing cancer through
PSA, or prostate-specific antigen, test surveillance. PSA testing
measures the level in the blood of this protein, which is
considered a biological marker of prostate cancer.
"Can't we consider the idea of watching these patients for a bit?" Penson asked. "An ounce of prevention is worth a pound of cure."
The U.S. National Cancer Institute has more about
treating prostate cancer.