QUALITY OF LIFE OUTCOMES WITH NEUROMODULATION IN PROSTATE CANCER SURVIVORS

Introduction

Prostate cancer (PCa) survivors experience significant impact on urinary function following treatment. While therapies to address stress urinary incontinence in PCa survivors have been well described, there is a dearth of information regarding urgency urinary incontinence and the role of sacral neuromodulation (SNM). This study aims to characterize outcomes for PCa survivors with medication refractory lower urinary tract symptoms who underwent SNM with Interstim.

Methods

A total of 50 male patients, all PCa survivors, from 12 institutions were included in a retrospective analysis. Patients were consented as part of the post-market Medtronic Product Surveillance Registry. Demographic information was collected, as well as outcomes data measured by the Patient Gobal Impression of Improvement (PGII) scale over multiple follow-up visits up to 96 months after SNM device placement.

Results

Patients were an average age of 73 at time of SNM device placement, with average BMI of 29. Ninety percent (45/50) were white, 8% (4/50) were Black or African American, and 2% (1/50) identified as Hispanic or Latino. Most patients (88%, 44/50) were enrolled following initial device placement, with 8% (4/50) undergoing replacement procedures. Forty-three percent (26/40) had previously undergone prostate surgery, and 51% (15/29) had previously undergone prostate radiation. The most common indication for device use was urinary urgency incontinence (54%, 27/50), followed by urinary urgency/frequency (24%, 12/50).

Mean follow up was 32 months, median follow up was 21 months, with a range from 0 months to 96 months. The majority reported improvement in symptoms as measured by the PGII at each follow up visit, with 73% (11/15) reporting improvement at 6 months, 83% (10/12) at 12 months, and 83% (5/6) at 72 months (Fig. 1).

Conclusions

Use of SNM in PCa survivors shows durable symptom improvement in this small cohort with mean follow up of almost 3 years. SNM should be considered as a treatment modality for patients with mixed LUTS after PCa treatment, aided by functional diagnosis with urodynamics. This study presents an opportunity for investigation into prospective studies to enhance our specificity for treatment to optimize outcomes in PCa survivors.