how big a problem their incontinence was, 38 percent said it was no problem, 34 percent said it was a small problem, and 9 percent said it was a moderate to big problem.

A number of interventions are available to treat the urinary problems associated with prostate cancer treatment:

• Medication for urge incontinence (e.g., oxybutynin, tolterodine)

• Diet and fluid intake (e.g., reduction in fluid intake; avoidance of substances that irritate the bladder such as coffee, tea, and acid juices; treatment of constipation)

• Pelvic floor rehabilitation (e.g., pelvic muscle exercise)

• Supportive interventions (e.g., good skin care, use of absorbent pads, condom catheters)

• Surgical interventions (e.g., urethral sphincters) are available for men with persistent or severe post-prostatectomy incontinence

There are no clinical practice guidelines specific to the management of urinary dysfunction for men with a history of prostate cancer, but a review article is available that describes these treatment options (Grise and Thurman, 2001).

Radiotherapy, either external beam or brachytherapy, can lead to significant bowel dysfunction, including bowel necrosis and symptoms such as rectal urgency or diarrhea (Penson and Litwin, 2003b). While many gastrointestinal problems were viewed as minor following treatment with external beam radiotherapy, a small proportion of men (10 percent or less) have reported severe bowel symptoms, including fecal soiling. For men treated with brachytherapy, bowel necrosis can occur, and it is estimated that problematic diarrhea may occur for 12 percent of men at 9 months following surgery (Krupski et al., 2000). Bowel dysfunction is fairly uncommon after prostatectomy. Interventions for bowel dysfunction include medication for cramping and diarrhea. Surgery, including colostomy, may be required for severe problems such as bowel necrosis.

Osteoporosis is a potentially serious complication of androgen deprivation therapy for prostate cancer (Smith, 2003). Such therapy may be used for men with advanced disease or recurrent prostate cancer. Androgen deprivation therapy either by bilateral orchiectomies (i.e., surgical removal of the testicles) or by treatment with a gonadotropin-releasing hormone