Urinary incontinence is a common persistent symptom after prostate cancer treatment, yet little is known about how its occurrence may differ for sexual and gender minorities. The aims of this study are to 1) describe urinary incontinence symptoms and severity experienced by gay and bisexual men (GBM) treated for prostate cancer, 2) identify if urinary incontinence symptoms and severity differ by the type of prostate cancer treatment, and 3) identify characteristics associated with severity of urinary incontinence.

Design: Baseline characteristics of 400 GBM enrolled in Restore 2, a randomized controlled trial testing the efficacy of an online rehabilitation program for urinary and sexual dysfunction after prostate cancer treatment. 
Methods: Participants were self-identified gay and bisexual prostate cancer patients in the United States  recruited mainly from online dating sites, prostate cancer survivor support groups, and social networking sites. Eligible participants had to have been diagnosed with prostate cancer with curative treatment (e.g., prostatectomy or radiation) completed, ongoing, or scheduled within 2 months of baseline. Participants were excluded if they did not speak English fluently or lived outside the United States. Baseline data was collected online using Qualtrics software© prior to participants’ being randomly assigned to a treatment or control group. Urinary incontinence symptoms and severity were measured with the International Consultation on Incontinence Questionnaire – short form (ICIQ). Participants self-reported their cancer treatment as surgery, radiation, surgery and radiation, or treatment other than surgery and radiation (e.g., cryotherapy, hormone therapy or chemotherapy). The following self-reported demographic, health, and cancer status characteristics were used to determine their association with urinary incontinence severity: age, race, obesity, number of alcoholic drinks consumed in a typical day, self-reported health, number of comorbidities, time since diagnosis and treatment, prostate cancer stage and Gleason score at time of diagnosis and type of cancer treatment. Descriptive statistics were used to describe sample characteristics, urinary incontinence symptoms and severity. Analysis of variance (for continuous variables) and chi-square tests (for categorical variables) were used to determine if urinary incontinence symptoms or severity differed by the type of prostate cancer treatment. Linear regression and Pearson correlation coefficients were used to determine what characteristics were associated with urinary incontinence severity.

Participants had a mean age of 63.5 years, were 5.3 years on average past treatment, and were treated with surgery (59%), radiation (28%), surgery and radiation (11%) or treatment other than surgery and radiation (2%). Over 80% of participants reported any urinary incontinence and 43% experienced at least daily incontinence.  The most common urinary incontinence symptoms were stress, post-void dribbling, urge and incontinence without awareness. Less common symptoms were nocturnal enuresis, mixed stress and urge, and continuous incontinence (see Table). Incontinence severity reported as the mean(SD) ICIQ score was 6.56(4.86) for the entire sample. Incontinence severity differed by cancer treatment (p<0.01). Patients treated with surgery & radiation had the highest ICIQ scores followed by surgery patients, radiation patients, and other treatment patients (see Table). Patients treated with surgery and radiation or surgery only were more likely to experience stress urinary incontinence (p<0.1) and insensible urinary incontinence incontinence (p<.01), while those treated with radiation only were more likely to experience urgency urinary incontinence (p<0.01).  Urinary incontinence severity was associated with obesity (r=0.14, beta [95% CI] = 1.76 [0.51, 3.00]), poorer self-reported health (r=-0.25, beta [95% CI] = -0.08 [-0.11, -0.05]), and an increased number of co-morbidities (r=0.18, beta [95% CI] = 0.62 [0.28, 0.96]). Urinary incontinence severity was not associated with age (r=-0.03, beta [95% CI] = -0.02 [-0.09, 0.05]), race (r=-0.0001, beta [95% CI] = 0.001 [-1.41, 1.41]), Gleason score at diagnosis (r=0.02), prostate cancer stage at diagnosis (r=0.07), time since diagnosis (r=0.06, beta [95% CI] = 0.06 [-0.03, 0.16]) or time since treatment (r=0.03, beta [95% CI] = -0.33 [-1.28, 0.63]).

These findings represent the first reports of urinary incontinence symptoms, severity, and associated characteristics for gay and bisexual prostate cancer survivors - providing new knowledge on potential health disparities and treatment targets for sexual minorities in this area. Urinary incontinence symptoms were associated with the type of prostate cancer treatment. Patients treated with surgery and radiation or surgery alone experienced greater severity of urinary incontinence and more symptoms of stress urinary incontinence and insensible urinary incontinence. Patients treated with radiation only experienced more symptoms of urgency urinary incontinence. Urinary incontinence severity was associated with obesity, poor self-reported health, and an increased number of co-morbidities, but not with prostate cancer status at the time of diagnosis or time since diagnosis. Study limitations include the use of a cross sectional design that prohibits causal inference, and results that may not generalize beyond GBM interested in enrolling in an online rehabilitation program for urinary and sexual dysfunction. The prevalence of urinary incontinence and its severity may be higher than that for GBM not interested in rehabilitation.

The type of prostate cancer treatment, obesity, co-morbidity, and poor self-rated health were associated with urinary incontinence symptoms and severity in GBM prostate cancer survivors. Treatments for GBM treated surgically should focus on treatments for stress urinary incontinence and insensible urinary incontinence, while those for GBM treated with radiation should focus on treatments for urgency urinary incontinence. Understanding these symptoms will help tailor treatments for this underserved population of sexual and gender minorities.