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Quality of Life After Open Radical Prostatectomy Compared with Robot-assisted Radical Prostatectomy.
Eur Urol Focus. 2019 05; 5(3):389-398.EU

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.

Authors+Show Affiliations

Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Solna, Sweden. Electronic address: anna.wallerstedt@karolinska.se.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.Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Solna, Sweden.Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland.Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Solna, Sweden.UCLA Center for Cancer Prevention & Control Research (CPCR), Fielding School of Public Health, Jonsson Comprehensive Cancer Center, University of California, California, LA, USA.Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.Department of Urology, Skåne University Hospital, Lund University, Lund, Sweden.Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Solna, Sweden.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.Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.

Pub Type(s)

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

Language

eng

PubMed ID

29366855

Citation

Wallerstedt, Anna, et al. "Quality of Life After Open Radical Prostatectomy Compared With Robot-assisted Radical Prostatectomy." European Urology Focus, vol. 5, no. 3, 2019, pp. 389-398.
Wallerstedt A, Nyberg T, Carlsson S, et al. Quality of Life After Open Radical Prostatectomy Compared with Robot-assisted Radical Prostatectomy. Eur Urol Focus. 2019;5(3):389-398.
Wallerstedt, A., Nyberg, T., Carlsson, S., Thorsteinsdottir, T., Stranne, J., Tyritzis, S. I., Stinesen Kollberg, K., Hugosson, J., Bjartell, A., Wilderäng, U., Wiklund, P., Steineck, G., & Haglind, E. (2019). Quality of Life After Open Radical Prostatectomy Compared with Robot-assisted Radical Prostatectomy. European Urology Focus, 5(3), 389-398. https://doi.org/10.1016/j.euf.2017.12.010
Wallerstedt A, et al. Quality of Life After Open Radical Prostatectomy Compared With Robot-assisted Radical Prostatectomy. Eur Urol Focus. 2019;5(3):389-398. PubMed PMID: 29366855.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Quality of Life After Open Radical Prostatectomy Compared with Robot-assisted Radical Prostatectomy. AU - Wallerstedt,Anna, AU - Nyberg,Tommy, AU - Carlsson,Stefan, AU - Thorsteinsdottir,Thordis, AU - Stranne,Johan, AU - Tyritzis,Stavros I, AU - Stinesen Kollberg,Karin, AU - Hugosson,Jonas, AU - Bjartell,Anders, AU - Wilderäng,Ulrica, AU - Wiklund,Peter, AU - Steineck,Gunnar, AU - Haglind,Eva, Y1 - 2018/02/01/ PY - 2017/08/07/received PY - 2017/11/27/revised PY - 2017/12/27/accepted PY - 2018/1/26/pubmed PY - 2020/10/10/medline PY - 2018/1/26/entrez KW - Prostate cancer KW - Quality of life KW - Radical prostatectomy KW - Robot-assisted radical prostatectomy SP - 389 EP - 398 JF - European urology focus JO - Eur Urol Focus VL - 5 IS - 3 N2 - 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. SN - 2405-4569 UR - https://www.unboundmedicine.com/medline/citation/29366855/Quality_of_Life_After_Open_Radical_Prostatectomy_Compared_with_Robot_assisted_Radical_Prostatectomy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2405-4569(17)30297-3 DB - PRIME DP - Unbound Medicine ER -