REPRESENTATIVE CASE 1
A 66-year-old man with a history of Gleason 4+3=7 prostate cancer treated 2 years earlier with external beam radiation therapy and hormonal ablation presents with worsening erectile function and urinary incontinence. He has no evidence of disease recurrence. He reports that his urinary incontinence is affecting his social interactions and that his erectile dysfunction is causing relational stress. Physical examination reveals incontinence induced by stress maneuvers. The patient is in diapers and his pad weight demonstrates 550 gm of urine leakage in a 24-hour period. His blood work shows recovery of his testosterone level. Given the degree of leakage and history of radiation, an artificial urinary sphincter is placed. On follow-up, he uses only one mini pad for protection during strenuous activity. He is able to socialize without concern regarding a bothersome urine odor. For his erectile dysfunction, he was started on a phosphodiesterase type 5 inhibitor, which has allowed him to obtain an erection firm enough for intercourse. These treatments have increased his quality of life, as demonstrated by patient-reported outcomes surveys.