Prospective comparison of the impact of robotic-assisted laparoscopic radical prostatectomy versus open radical prostatectomy on health-related quality of life and decision regret

Introduction: There is no conclusive evidence that the robotic-assisted laparoscopic radical prostatectomy (RARP) is superior to conventional open radical prostatectomy (ORP) when it comes to recovery of urinary and sexual function, and that the former surgical option results in less decision regret. Methods: Patients scheduled for both surgical procedures were surveyed prior to surgery, and then again at 6 and 12 months following treatment using the sexual and urinary modules of the Expanded Prostate Cancer Index Composite (EPIC) measure. Decision regret was measured at 12 months. Propensity score regression adjustment was used to account for differences between treatment groups by summarizing all covariate information into a single probability and to simulate randomization. Results: At 12 months, urinary summary scores approached baseline levels, while urinary bother scores had returned to baseline. Sexual summary and bother mean scores decreased by about half of what they were at baseline for both treatment groups at 6 and 12 months. No significant differences in the groups' sexual summary and bother domains were identified at either 6 or 12 months. Both groups' scores for decision regret were low. Moderate correlations (r(2) range -0.333 to -0.368) were between current levels of urinary and sexual function and decision regret at 12 months. Conclusion: The results of our study found no significant difference in health-related quality of life outcomes based on surgical procedure at 12 months. Moreover, patients in both groups reported low levels of decision regret at 12 months. Further multi-site prospective studies are required to address this study's limitations.