Abstract
The aim of this study was to assess clinically meaningful differences of preoperative lower urinary tract symptoms (LUTS) and quality of life (QoL) before and after robot-assisted radical prostatectomy (RARP). Therefore we identified 5506 RARP patients from 2007 to 2018 with completed International Prostate Symptom Score (IPSS) and -QoL questionnaires before and 12 months after RARP in our institution. Marked clinically important difference (MCID) was defined by using the strictest IPSS-difference of − 8 points. Multivariable logistic regression analyses (LRM) aimed to predict ∆IPSS ≤ − 8 and were restricted to RARP patients with preoperatively moderate (IPSS 8–19) vs. severe (IPSS 20–35) LUTS burden (n = 2305). Preoperative LUTS was categorized as moderate and severe in 37% (n = 2014) and 5.3% of the complete cohort (n = 291), respectively. Here, a postoperative ∆IPSS ≤ − 8, was reported in 38% vs. 90%. In LRM, younger age (OR 0.98, 95%CI 0.97–0.99; p = 0.007), lower BMI (OR 0.94, 95%CI 0.92–0.97; p < 0.001), higher preoperative LUTS burden (severe vs. moderate [REF.] OR 15.6, 95%CI 10.4–23.4; p < 0.001), greater prostate specimen weight (per 10 g, OR 1.12, 95%CI 1.07–1.16; p < 0.001) and the event of urinary continence recovery (OR 1.66 95%CI 1.25–2.21; p < 0.001) were independent predictors of a marked LUTS improvement after RARP. Less rigorous IPSS-difference of − 5 points yielded identical predictors. To sum up, in substantial proportions of patients with preoperative moderate or severe LUTS a marked improvement of LUTS and QoL can be expected at 12 months after RARP. LRM revealed greatest benefit in those patients with preoperatively greatest LUTS burden, prostate enlargement, lower BMI, younger age and the event of urinary continence recovery.
Highlights
Abbreviations ADT Androgen deprivation therapy, i.e. antiandrogen and/or luteinizing hormone-releasing hormone antagonist or agonist therapy BMI Body mass index benign prostatic hyperplasia (BPH) Benign prostate hyperplasia CAPRA-S Postsurgical Cancer of the Prostate Risk Assessment Score International Prostate Symptom Score (IPSS) International Prostate Symptoms Score LRM Logistic regression model lower urinary tract symptoms (LUTS) Lower urinary tract symptoms marked clinical important difference (MCID) Marked clinically important differences multivariable analyses (MVA) Multivariable cox regression analyses PCa Prostate cancer PSA Prostate specific antigen quality of life (QoL) Quality of life
A substantial proportion of patients diagnosed with PCa and scheduled for radical prostatectomy (RP) suffer from preoperatively clinically important LUTS3–5
Most series focus on changes of mean IPSS or QoL scores but do so without reporting minimal or marked clinically important differences (MCIDs) of pre- vs. postoperative LUTS
Summary
Abbreviations ADT Androgen deprivation therapy, i.e. antiandrogen and/or luteinizing hormone-releasing hormone antagonist or agonist therapy BMI Body mass index BPH Benign prostate hyperplasia CAPRA-S Postsurgical Cancer of the Prostate Risk Assessment Score IPSS International Prostate Symptoms Score LRM Logistic regression model LUTS Lower urinary tract symptoms MCID Marked clinically important differences MVA Multivariable cox regression analyses PCa Prostate cancer PSA Prostate specific antigen QoL Quality of life. Prostate cancer (PCa) and benign prostatic hyperplasia (BPH) occur in men of advanced age and are frequently coexistent Both may be associated with lower urinary tract symptoms (LUTS) and increased serum PSA levels. A substantial proportion of patients diagnosed with PCa and scheduled for radical prostatectomy (RP) suffer from preoperatively clinically important LUTS3–5 Such LUTS usually reduce patients’ quality of life (QoL), driven by either storage- (e.g. urgency, nocturia) or voiding-symptoms (e.g. intermittency, weak voiding stream)[6,7] and can even have an impact on mortality r isk[8]. Most series focus on changes of mean IPSS or QoL scores but do so without reporting minimal or marked clinically important differences (MCIDs) of pre- vs postoperative LUTS. We assessed clinically meaningful marked and moderate differences of pre- vs. postoperative LUTS and associated QoL 12 months after RARP and identified predictors of post-RARP improvement
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