Quality of Life After Open Radical Prostatectomy Compared with Robot-assisted Radical Prostatectomy

Anna Wallerstedt; Tommy Nyberg; Stefan Carlsson; Thordis Thorsteinsdottir; Johan Stranne; Stavros I Tyritzis; Karin Stinesen Kollberg; Jonas Hugosson; Anders Bjartell; Ulrica Wilderäng; Peter Wiklund; Gunnar Steineck; Eva Haglind

doi:10.1016/j.euf.2017.12.010

Quality of Life After Open Radical Prostatectomy Compared with Robot-assisted Radical Prostatectomy

Eur Urol Focus. 2019 May;5(3):389-398. doi: 10.1016/j.euf.2017.12.010. Epub 2018 Feb 1.

Affiliations

¹ Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Solna, Sweden. Electronic address: anna.wallerstedt@karolinska.se.
² Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Solna, Sweden; Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
³ Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Solna, Sweden.
⁴ Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland.
⁵ Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
⁶ UCLA Center for Cancer Prevention & Control Research (CPCR), Fielding School of Public Health, Jonsson Comprehensive Cancer Center, University of California, California, LA, USA.
⁷ Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁸ Department of Urology, Skåne University Hospital, Lund University, Lund, Sweden.
⁹ Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
¹⁰ Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Oncology and Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institutet, Solna, Sweden.
¹¹ Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.

PMID: 29366855
DOI: 10.1016/j.euf.2017.12.010

Abstract

Background: Surgery for prostate cancer has a large impact on quality of life (QoL).

Objective: To evaluate predictors for the level of self-assessed QoL at 3 mo, 12 mo, and 24 mo after robot-assisted laparoscopic (RALP) and open radical prostatectomy (ORP).

Design, setting, and participants: The LAParoscopic Prostatectomy Robot Open study, a prospective, controlled, nonrandomised trial of more than 4000 men who underwent radical prostatectomy at 14 centres. Here we report on QoL issues after RALP and ORP.

Outcome measurements and statistical analysis: The primary outcome was self-assessed QoL preoperatively and at 3 mo, 12 mo, and 24 mo postoperatively. A direct validated question of self-assessed QoL on a seven-digit visual scale was used. Differences in QoL were analysed using logistic regression, with adjustment for confounders.

Results and limitations: QoL did not differ between RALP and ORP postoperatively. Men undergoing ORP had a preoperatively significantly lower level of self-assessed QoL in a multivariable analysis compared with men undergoing RALP (odds ratio: 1.21, 95% confidence interval: 1.02-1.43), that disappeared when adjusted for preoperative preparedness for incontinence, erectile dysfunction, and certainty of being cured (odds ratio: 1.18, 95% confidence interval: 0.99-1.40). Incontinence and erectile dysfunction increased the risk for poor QoL at 3 mo, 12 mo, and 24 mo postoperatively. Biochemical recurrence did not affect QoL. A limitation of the study is the nonrandomised design.

Conclusions: QoL at 3 mo, 12 mo, and 24 mo after RALP or ORP did not differ significantly between the two techniques. Poor QoL was associated with postoperative incontinence and erectile dysfunction but not with early cancer relapse, which was related to thoughts of death and waking up at night with worry.

Patient summary: We did not find any difference in quality of life at 3 mo, 12 mo, and 24 mo when open and robot-assisted surgery for prostate cancer were compared. Postoperative incontinence and erectile dysfunction were associated with poor quality of life.

Keywords: Prostate cancer; Quality of life; Radical prostatectomy; Robot-assisted radical prostatectomy.

Publication types

Clinical Trial
Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Erectile Dysfunction / epidemiology
Erectile Dysfunction / etiology
Humans
Male
Middle Aged
Neoplasm Grading
Prostatectomy* / adverse effects
Prostatectomy* / methods
Prostatectomy* / statistics & numerical data
Prostatic Neoplasms / surgery*
Quality of Life*
Robotic Surgical Procedures* / adverse effects
Robotic Surgical Procedures* / methods
Robotic Surgical Procedures* / statistics & numerical data
Time Factors
Urinary Incontinence / epidemiology
Urinary Incontinence / etiology