Men are typically (though not always) offered behavioral training soon after they undergo prostate removal, Dr. Goode says, but this is the first study to show it can help men many years after surgery.
The study included more than 200 men between the ages of 51 and 84 who had their prostates removed and had experienced incontinence for at least one year, and as many as 17 years. The participants received behavioral therapy alone, or behavioral therapy in addition to biofeedback training and electrical stimulation of the pelvic floor muscles. Men in the control group received neither treatment, but could take their pick once the study was over.
The average number of incontinence episodes per week fell by more than 50% in the men who received behavioral therapy. (Biofeedback and electrical stimulation did not appear to make any difference.) By contrast, the average number of episodes in the control group fell by just 24%.
Although it’s not perfect, behavioral therapy may be the best option available for incontinence besides surgical treatment, says Dr. Penson. Surgery to correct incontinence is fairly straightforward and effective, but it isn’t always appealing to men who have had their prostates removed, he points out. “Who wants to have a second surgery?”
Medications can be helpful for urge incontinence, but they have side effects, Dr. Goode says.
The challenge of treating incontinence suggests that prostate removal may be a premature treatment for cancer in many cases, Dr. Goode adds. “I do think we probably underuse watchful waiting, active surveillance,” she says. “Particularly in the oldest age group, I think we overtreat men.”