Abstract
PurposeIntroduction of robot-assisted radical prostatectomy (RARP) has revolutionized the therapeutic landscape of organ-confined prostate cancer (PCa). However, comparative analyses focused on health-related quality of life (HRQOL) after RARP and open retropubic prostatectomy (ORP) are sparse.MethodsIn the current retrospective analysis,inclusion criteria encompassed PSA ≤ 10 ng/ml, ≤ pT2c, ISUP ≤ 3, age ≤ 65 years, and preoperative continence. A propensity score-matched patient cohort [n = 418 (ORP: 209, RARP: 209)] was created and HRQOL was prospectively assessed based on validated questionnaires (EORTC QLQ-C30) preoperatively, 3 months, 12 months, and 24 months postoperatively. Primary endpoint was good general HRQOL based on previously published cut-off values. Erectile function was measured via IIEF-5, urinary continence via ICIQ-SF questionnaire. Multivariable analysis included binary logistic regression models (p < 0.05).ResultsOpen retropubic prostatectomy and RARP cohorts were well balanced. General HRQOL was significantly higher for ORP compared to RARP after 3 months (70.1 vs. 61.6, p = 0.001), but not at the remaining follow-up time points. There were no significant differences for the remaining QLQ-C30 functioning and symptom scores. In multivariable analysis stratified for IIEF-5 and ICIQ-SF scores and surgeon experience, RARP could be confirmed as a marginally independent predictor for lower ratios of good general HRQOL after 3 months (OR 0.464, 95% CI 0.215–0.999; p = 0.050) without any differences at the remaining time points.ConclusionsThe current study addresses various HRQOL outcomes over a postoperative period of up to 2 years in a homogenous propensity score-matched contemporary cohort. Marginally better general HRQOL outcomes could be detected for ORP compared to RARP 3 months postoperatively.
Highlights
Introduction of robot-assisted radical prostatectomy (RARP) has already revolutionized the therapeutic landscape of organ-confined prostate cancer over the last decade
After 3 months, we found slightly better continence results for open retropubic prostatectomy (ORP) compared to RARP based on the respective mean ICIQ-SF total scores (3.9 vs. 5.3; p = 0.003). 12 months and 24 months postoperatively, ICIQ-SF scores declined for both groups with no significant differences regarding urinary continence between ORP and RARP
Regarding general health-related quality of life (HRQOL), we found significantly higher mean values for ORP compared to RARP after 3 months (70.1 vs. 61.6, p = 0.001), but not after the remaining followup periods
Summary
Introduction of robot-assisted radical prostatectomy (RARP) has already revolutionized the therapeutic landscape of organ-confined prostate cancer over the last decade. The authors did not observe significantly different outcomes between open retropubic prostatectomy (ORP) and. The authors found a biochemical recurrence rate of 9% for ORP compared to 3% for RARP, but stressed out that postoperative oncological management was not standardized between the participating centres [2]. In a recent comparative study including more than 10,000 radical prostatectomies (RP), no statistically significant differences regarding 48-month BCR could be observed [4]. We provide short- and mid-term HRQOL and functional data from a large propensity score-matched patient cohort with low- and intermediate-risk localized prostate cancer that underwent ORP or RARP by experienced high-volume surgeons
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