ABSTRACT
Permanent prostate brachytherapy has evolved over the last decade as a treatment option for early stage prostate cancer. Excellent five year biochemical control rates have been shown, suggesting that radical prostatectomy, threedimensional conformal radiation therapy, and brachytherapy are relatively equally effective for the treatment of favorable risk disease.1-9 Issues about quality of life are increasingly important to patients faced with choosing a treatment modality and to the physicians who counsel them. Quality of life issues often include rectal bleeding or diarrhea, sexual dysfunction, irritative urinary symptoms, and urinary incontinence. Although the majority of papers have focused on the obstructive urinary symptoms patients have experienced, little has been published regarding urinary incontinence. Urinary incontinence has been associated with radical prostatectomy and according to the National Medicare Experience over 47% of patients have reported some degree of incontinence following this procedure.10 Rates over a broad range of 0-40% following brachytherapy have been reported.4,5,11-15 Many reports however, contain physician-acquired information, which has been shown to correlate poorly with data collected with patient self-assessment questionnaires.10,16-20 Much of the published literature on this topic lacks dosimetric information and does not specifically include urinary incontinence in the grading scale. Attempts to establish widespread use of validated self-assessment questionnaires to adequately address incontinence have been unsuccessful to date. Although the incidence of incontinence after brachytherapy is likely less than after radical prostatectomy, it may not be as low as presently believed. We evaluated the incidence of urinary incontinence and attempted to determine predictive factors for this complication.
