Login to Access Video or Poster Abstract: MP14-12
Sources of Funding: This research was supported by the Transdisciplinary Research on Energetics and Cancer (TREC) Center at Washington University in St. Louis. The TREC Center is funded by the National Cancer Institute at National Institutes of Health (NIH) (U54 CA155496), (http://www.nih.gov/) Washington University and the Siteman Cancer Center (http://www.siteman.wustl.edu/).

Introduction

Although research on prostate cancer survivorship points to the importance of shifting our perspective from patient function to patient satisfaction measures, few studies have focused on urinary symptom bother (UB) or its relation to urinary function (UF) in prostate cancer patients undergoing radical prostatectomy (RP). This question is important because it may inform possible non-functional mechanisms for UB, and thus modifiable targets to improve patient satisfaction following RP. Therefore, we examined the degree of concordance between patient-reported UF and UB in the Prostatectomy, Incontinence and Erectile function (PIE) study.

Methods

PIE participants were recruited from 2011 to 2014 at Washington University School of Medicine and Brigham & Women’s Hospital. Patient-reported outcome measures (PROMs), including UF and UB, were measured by the Expanded Prostate Cancer Index Composite (EPIC-50) pre and 5 weeks post RP in 384 men. Spearman’s rank correlation coefficients were used to describe the concordance between UF and UB.

Results

We observed overall agreement between UF and UB (r=0.51, see Table 1). However, two distinct groups with differing function and bother were observed: 1) men with high function and bother pre-RP (17.7%), and 2) men with low function and bother 5 weeks post-RP (27.9%). The group with high baseline urinary function and high bother (17.7%) was largely explained by differences in the components assessed by the UF and UB scales. Both of these scales measure incontinence, but the UB scale additionally measures irritative/obstructive symptoms, such as seen in men with benign prostatic hyperplasia (BPH). Splitting the UB scale into two (one for incontinence and one for irritative/obstructive symptoms), or limiting the analyses to men with non-enlarged prostates who are less likely to have BPH, resulted in considerably better agreement between UF and UB (r=0.63 for non-enlarged vs r=0.48 for enlarged prostate size).

Conclusions

In a pre-surgical cohort of prostate cancer patients, co-existing BPH-associated irritative/obstructive symptoms may distort measurement of UB using EPIC. In natural history studies that compare pre-to post-RP outcomes, splitting incontinence-related UB and irritative/obstructive symptom-related UB may improve the utility of this PROM.

Funding

This research was supported by the Transdisciplinary Research on Energetics and Cancer (TREC) Center at Washington University in St. Louis. The TREC Center is funded by the National Cancer Institute at National Institutes of Health (NIH) (U54 CA155496), (http://www.nih.gov/) Washington University and the Siteman Cancer Center (http://www.siteman.wustl.edu/).