Behavioral Therapy Can Reduce Incontinence After Prostate Surgery

Behavioral health therapy may result in fewer incontinence episodes among patients who have continued to suffer from the problem a year or more after a prostatectomy, a recent study found.¹

The study sought to evaluate the effectiveness of behavioral therapy for reducing persistent incontinence in men who had a prostatectomy and to determine whether biofeedback and pelvic floor electrical stimulation enhance the effectiveness of behavioral therapy.

The prospective randomized controlled trial involved 208 men aged 51 through 84 years with incontinence persisting one to 17 years after radical prostatectomy. The trial was conducted at a university and two VA continence clinics (2003-2008) and included a one-year follow-up after active treatment. The subjects were 24% African American and 75% white.

The men were stratified by type and frequency of incontinence, and randomized to one of three groups: eight weeks of behavioral therapy (pelvic floor muscle training and bladder control strategies); behavioral therapy plus in-office, dual-channel electromyograph biofeedback and daily home pelvic floor electrical stimulation at 20 Hz, current up to 100 mA (behavior plus); or delayed treatment, which served as the control group.

The study authors found that, among patients with post-prostatectomy incontinence for at least one year, eight weeks of behavioral therapy, compared with a delayed-treatment control, resulted in fewer incontinence episodes. The addition of biofeedback and pelvic floor electrical stimulation did not result in greater effectiveness.

The mean number of incontinence episodes decreased from 28 to 13 per week after behavioral therapy, which was significantly greater than the reduction from 25 to 21 observed among controls (P = 0.001).

1. Goode PS, Burgio KL, Johnson TM 2nd, Clay OJ, Roth DL, Markland AD, Burkhardt JH, Issa MM, Lloyd LK. Behavioral therapy with or without biofeedback and pelvic floor electrical stimulation for persistent postprostatectomy incontinence: a randomized controlled trial. JAMA. 2011 Jan 12;305(2):151-9.

Study Suggests Relationship Between Statin Use and Lower Incidence of Prostate Cancer

Statin use is associated with a reduced risk for total and high-grade prostate cancer, and increased levels of serum cholesterol are associated with higher risk for total and high-grade prostate cancer, a recent study found.¹

Few risk factors for high-grade prostate cancer are known, and few prevention strategies exist, according to the study. Statins have been proposed as a possible treatment to prevent prostate cancer

The study authors identified 55,875 men from the VA New England Healthcare System taking either a statin or antihypertensive medication. The authors used age- and multivariable-adjusted Cox proportional hazard models to calculate hazard ratios and 95% confidence intervals for prostate cancer incidence among the patients taking statins, compared with patients taking antihypertensive medications. The authors performed similar analyses for all lipid parameters, including total cholesterol, examining each lipid parameter as a continuous variable and by quartiles. All statistical tests were two-sided.

Compared with men taking an antihypertensive medication, statin users were 31% less likely to be diagnosed with prostate cancer. Furthermore, statin users were 14% less likely to be diagnosed with low-grade prostate cancer and 60% less likely to be diagnosed with high-grade prostate cancer, compared with antihypertensive medication users. Increased levels of total cholesterol also were associated with both total and high-grade prostate cancer incidence but not with low-grade prostate cancer incidence.

The findings indicate that clinical trials of statins for prostate cancer prevention are warranted, according to the study.

1. Wildon R. Farwell, Leonard W. D’Avolio, Richard E. Scranton, Elizabeth V. Lawler and J. Michael Gaziano. Statins and Prostate Cancer Diagnosis and Grade in a Veterans Population. JNCI J Natl Cancer Inst (2011).

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