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

Wallerstedt, Anna; Nyberg, Tommy; Carlsson, Stefan; Thorsteinsdottir, Thordis; Stranne, Johan; Tyritzis, Stavros I.; Stinesen Kollberg, Karin; Hugosson, Jonas; Bjartell, Anders LU and Wilderäng, Ulrica, et al. (2018) In European Urology Focus
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... (More)

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. In this large prospective multicentre study evaluating quality of life (QoL) after open versus robot-assisted radical prostatectomy we found that the surgical approach did not affect QoL postoperatively. Poor QoL was related to postoperative incontinence and erectile dysfunction.

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Prostate cancer, Quality of life, Radical prostatectomy, Robot-assisted radical prostatectomy
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European Urology Focus
publisher
Elsevier
external identifiers
  • scopus:85040650675
  • pmid:29366855
ISSN
2405-4569
DOI
10.1016/j.euf.2017.12.010
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English
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yes
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723ded24-2cc7-49ee-b353-4bbc186cd0fc
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2018-02-05 12:46:46
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2018-02-06 03:00:09
@article{723ded24-2cc7-49ee-b353-4bbc186cd0fc,
  abstract     = {<p>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. In this large prospective multicentre study evaluating quality of life (QoL) after open versus robot-assisted radical prostatectomy we found that the surgical approach did not affect QoL postoperatively. Poor QoL was related to postoperative incontinence and erectile dysfunction.</p>},
  author       = {Wallerstedt, Anna and Nyberg, Tommy and Carlsson, Stefan and Thorsteinsdottir, Thordis and Stranne, Johan and Tyritzis, Stavros I. and Stinesen Kollberg, Karin and Hugosson, Jonas and Bjartell, Anders and Wilderäng, Ulrica and Wiklund, Peter and Steineck, Gunnar and Haglind, Eva},
  issn         = {2405-4569},
  keyword      = {Prostate cancer,Quality of life,Radical prostatectomy,Robot-assisted radical prostatectomy},
  language     = {eng},
  publisher    = {Elsevier},
  series       = {European Urology Focus},
  title        = {Quality of Life After Open Radical Prostatectomy Compared with Robot-assisted Radical Prostatectomy},
  url          = {http://dx.doi.org/10.1016/j.euf.2017.12.010},
  year         = {2018},
}