BLADDER CONTROL & PROSTATE CANCER
WHAT CAN I DO NOW THAT I HAVE IT?

Prostate Cancer Treatments

According to the results of a study published in The American Journal of Medicine, aggressive treatment of prostate cancer in men aged 75 or older was linked with worse quality of life and only a small survival benefit.

A factor that may influence treatment choice is the health of the patient. Patients who have a short life expectancy due to other chronic health problems may be less likely to benefit from active treatment than patients with a longer life expectancy. Although health status isn’t necessary linked with age, researchers continue to explore how treatment outcomes vary by age.

To assess prostate cancer treatment outcomes among elderly men, researchers evaluated 465 prostate cancer patients between the ages of 75 and 84. One hundred and seventy-five of the men had been treated with prostatectomy or radiation therapy (the aggressive therapy group) and 290 had received no treatment or hormonal therapy only (the conservative management group).

By two years after prostate cancer diagnosis, over 80% of the deaths among study participants were from causes other than prostate cancer. Men who received aggressive treatment were less likely to die of prostate cancer; the difference in risk between treatment groups, however, was only 6%. Men who received aggressive treatment were more likely to report daily urinary leakage and to be bothered by urinary and sexual problems.

The researchers conclude that aggressive treatment of prostate cancer slightly improved survival among prostate cancer patients aged 75 or older, but decreased quality of life. The researchers note that “Physicians and older patients should consider these outcomes in making decisions about screening and treatment.”

Cancer Treatments Can Succeed

A radiation treatment commonly used in prostate cancer patients older than 55 works just as well in younger men with the same level of disease, a preliminary study finds.

The findings aren't yet definitive, and it's not clear if they'll lead to any changes in how prostate cancer is treated generally. But the study results do poke a hole in a common assumption that younger men need more aggressive treatment than older patients, said lead author Dr. Andre Konski, clinical research director of the Radiation Oncology Department at the Fox Chase Cancer Center in Philadelphia.

"Patients need to factor all risks and benefits, but external radiation should be given as a viable option for patients to consider," Konski said.

According to the American Cancer Society (ACS), prostate cancer is the second leading cancer killer for men. An estimated one in six men will receive a prostate cancer diagnosis in their lifetime, and more than 30,000 Americans currently die of the disease each year.

Prostate cancer tends to be more aggressive in younger patients, and doctors often respond with more drastic treatments, such as removal of the prostate.

In the new study, Konski and colleagues looked at how 84 men who underwent external beam radiation treatment for prostate cancer fared five years after their diagnosis. They compared the outcomes of patients under 55 with those aged 60-69 and those 70 and older. All the men were in similar stages of the disease.

Konski's team found no statistically significant difference between how men in the three groups were doing at the five-year mark. Ninety-four percent of those in the youngest group were still alive, compared to 95 percent of those 60-69 and 87 percent of those 70 and older. Also, between 96 percent and 98 percent of the living patients showed no signs of prostate cancer spread.

Konski cautioned that the results don't say anything about younger patients with more aggressive forms of prostate cancer. "They'll have potentially different outcomes," he said. And he added that the study also doesn't mean that radiation is better than other treatments. However, the research does suggest that "when you have a younger man who has an earlier-stage disease, he would do as well as an older man does," Konski said.

Another expert said the study is still too short to draw definite conclusions. Dr. Durado Brooks, director of prostate cancer for American Cancer Society, noted that it can take a long time for prostate cancer to recur, "and while a five-year follow-up study is encouraging, it's by no means definitive."

As for choices about cancer treatment, "this is just one little piece of the puzzle," Brooks said. "We don't have enough definitive information to say this is the treatment you should choose."

A few simple lifestyle changes may help the more than 13 million Americans with urinary incontinence regain control of their daily lives, one expert says.

This loss of bladder control is more common in people 65 and older and affects women more often than men. While drugs and minimally invasive surgery can help treat the condition, people with urinary incontinence can also take some important steps on their own, said Dr. Carol Figuers, an associate clinical professor in the division of physical therapy at Duke University Medical Center.

For example, "decreasing or eliminating caffeine intake can help reduce bladder urges," Figuers said in a prepared statement.

Caffeine can irritate and stimulate the bladder and cause urgent, frequent urination and increased urine production, she explained. Individuals who drink more than two caffeinated beverages a day should gradually reduce their caffeine intake to avoid possible withdrawal symptoms such as headache or sleepiness. Substituting non-caffeinated drinks in place of coffee, tea and colas can go a long way to reducing incontinence, the Duke expert said.

On the other hand, it’s not a good idea to cut back on intake of liquids in an attempt to reduce the urge to urinate, Figuers said. Lack of liquids can cause dehydration, which can cause urine to become concentrated and actually result in increased bladder urgency, foul-smelling urine and, sometimes, bladder infection.

Drinking too much alcohol and eating too much spicy food can also aggravate incontinence. Figuers said that bladder training and "timed voiding" can help control wayward bladders. Developing a regular schedule of urinating can help bladders hold more urine and gradually increase the time between urination. Holding urine too long can increase the risk of urinary tract infection, however.

Urinary incontinence is often linked to a weakening of the pelvic floor muscles. Pelvic floor muscle exercises (Kegel exercises) can strengthen those muscles and help prevent urine leakage, Figuers said.

"An individual can learn to improve both the strength and endurance of this special muscle group through regular exercise," she explained. "They’re most effective when a person is able to isolate the pelvic floor muscle and exercise that muscle specifically."

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