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Abstract
BackgroundRobot-assisted radical prostatectomy (RARP) rates have been increasing worldwide despite a lack of evidence of superior patient-reported outcomes (PROs) compared to open radical prostatectomy (ORP).MethodsThis retrospective study included men who contributed data to the Prostate Cancer Outcomes Registry-Victoria (PCOR-Vic), underwent ORP or RARP between January 2014 and May 2018, and completed the EPIC-26 questionnaire 12 months post-surgery. Urinary and sexual bother items, the urinary incontinence domain score, the urinary irritative/obstructive domain score, the sexual domain score and the pad usage item from the EPIC-26 questionnaire were compared between the two cohorts. Unmatched and propensity score matched cohorts were used to determine if there were differences in urinary and sexual PROs between ORP and RARP after accounting for the patient case-mix and surgeon characteristics.ResultsOf 3826 patients undergoing radical prostatectomy (RP), 1047 received ORP and 2779 received RARP. Propensity score matching reduced the magnitude of the observed differences in four out of six outcomes (urinary bother, urinary incontinence domain, pad usage and sexual domain). Using a propensity score matched cohort, there were no statistically significant differences for RARP patients, compared to ORP patients, in terms of urinary bother (Rd = 0.47%, P = 0.707), urinary incontinence domain scores (Coeff = − 0.84, P = 0.506), urinary irritative/obstructive domain scores (Coeff = 1.03, P = 0.105), pad usage (Rd = − 0.75%, P = 0.771) and sexual bother (Rd = − 0.89%, P = 0.731). RARP patients had slightly higher sexual domain scores (Coeff = 3.65, P = 0.005).ConclusionThere were no differences in urinary PROs between ORP and RARP when assessed 12 months post-surgery. The sexual domain slightly favoured RARP, however this was not deemed clinically significant.
Highlights
Robot-assisted radical prostatectomy (RARP) rates have been increasing worldwide despite a lack of evidence of superior patient-reported outcomes (PROs) compared to open radical prostatectomy (ORP)
Rechtman et al BMC Urology (2022) 22:18 radical prostatectomy (ORP) and robot-assisted radical prostatectomy (RARP) are the two main Radical prostatectomy (RP) approaches performed in Victoria [2]
Differing baseline characteristics included that RARP patients were more likely to have low or intermediate National Comprehensive Cancer Network (NCCN) disease risk (78.3% vs. 72.0%, p < 0.001) and reside in postcodes in the top quintile of the index of relative socio-economic advantage and disadvantage (IRSAD) (43.9% vs. 34.3%, p < 0.001), compared to ORP patients (Table 1)
Summary
Robot-assisted radical prostatectomy (RARP) rates have been increasing worldwide despite a lack of evidence of superior patient-reported outcomes (PROs) compared to open radical prostatectomy (ORP). Minimally invasive surgeries such as RARP have gained popularity globally due to the potential for reduced morbidity [8] This may be due to improved perioperative outcomes, such as decreased blood loss, improved short-term postoperative outcomes, such as reduced postoperative pain and length of hospital stay [6], and clinician and patient preference [8]. Due to conflicting evidence and its increasing adoption [12], ongoing comparison of outcomes is warranted that is focussed on issues that impact quality of life For this reason, observational studies and prostate cancer clinical registries have grown in number [13]. Population-based clinical registries allow stronger inferences to be made about the population compared to single- or multi-centre studies due to volume-outcome relationships [14]
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