Fecal incontinence after prostate cancer irradiation: a systematic literature review.
Daniel Benizri, Emilie Duchalais-Dassonneville, Mathieu Gautier et al.
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In 30 seconds
This systematic review synthesized evidence on fecal incontinence (FI) after definitive or adjuvant/salvage radiotherapy for prostate cancer, including 54 articles identified through a PRISMA-guided search. Reported FI incidence ranged from 1 to 12%; symptoms were most often flatulence or liquid stool leakage, while severe cases requiring pads were uncommon. The review describes functional, morphological, and neurogenic contributors, with risk factors and dose effects varying across studies. It concludes that FI is likely underestimated because assessment definitions and tools are not standardized, and identifies development of a validated scoring system as a priority.
Key findings
- Across included studies, reported FI incidence after prostate radiotherapy ranged from 1 to 12%.
- Symptoms most often involved flatulence or liquid stool leakage; severe FI requiring pads was uncommon.
- Risk factors included advanced age, prior abdominal surgery, vascular comorbidities, chronic inflammatory bowel disease, hemorrhoids, and rectal urgency during radiotherapy.
- The review suggests keeping mean anal canal dose below 37 Gy, while noting that further studies are needed to define precise dose constraints.
Why it matters
FI is a clinically significant late gastrointestinal toxicity that may be missed or inconsistently recorded after prostate radiotherapy. Awareness of its varied presentation and reported risk factors can support more complete assessment and discussion of prevention and management options. Standardized measurement is needed to make incidence estimates comparable and strengthen evidence for dose constraints and interventions.
What to keep in mind
The evidence is heterogeneous, with no universally applied FI definition or assessment tool; precise dose constraints remain uncertain.