Optimizing functional outcomes in prostate cancer: a new perspective on early artificial urinary sphincter implantation before salvage radiotherapy in prostate cancer treatment.

Abstract

Introduction: Stress urinary incontinence is a significant adverse effect following radical prostatectomy for prostate cancer. Various factors, including surgical technique and patient characteristics, influence the incidence of incontinence. Early artificial urinary sphincter implantation prior to salvage radiotherapy may improve functional outcomes and quality of life for these patients. The objective of our study is to address the current gap in research regarding the effects of radiotherapy on tissues surrounding the artificial urethral sphincter, particularly when the artificial urethral sphincter (AUS) is implanted before, rather than after, radiotherapy.

Material and methods: This pilot study analysed the impact of early AUS implantation in 2 prostate cancer patients who underwent radical prostatectomy (RP) and subsequently received salvage radiotherapy (SRT) due to biochemical recurrence. Radiation dose distribution and functional outcomes, including continence rates and complications, were evaluated.

Results: Both patients experienced significant improvements in continence post-AUS implantation, using fewer pads daily. However, a slight deterioration in AUS effectiveness was observed post-radiotherapy, with an increase in pad usage. Radiation doses at the cuff site were relatively low, but mild tissue reactions were noted.

Conclusions: Early AUS implantation before SRT shows promise in enhancing urinary continence and overall quality of life in prostate cancer patients. Despite mild complications, the approach appears feasible and beneficial. Further studies are needed to confirm these findings and optimise treatment sequencing.