The burden of urinary incontinence and urinary bother among elderly prostate cancer survivors

Ryan P. Kopp, Lynn M. Marshall, Patty Y. Wang, Douglas C. Bauer, Elizabeth Barrett-Connor, J. Kellogg Parsons

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


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. Design, setting, and participants A cross-sectional analysis of 5990 participants in the Osteoporotic Fractures in Men Research Group, a cohort study of community-dwelling men ≥65 yr. Outcome measurements and statistical analysis 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). Results and limitations 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.

Original languageEnglish (US)
Pages (from-to)672-679
Number of pages8
JournalEuropean Urology
Issue number4
StatePublished - Oct 2013
Externally publishedYes


  • Aging male
  • Elderly
  • Epidemiology
  • Incontinence
  • Lower urinary tract symptoms
  • Prostate cancer
  • Prostate cancer treatment
  • Urinary bother

ASJC Scopus subject areas

  • Urology


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