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BACKGROUND:
Robot assisted radical prostatectomy (RARP) with pelvic lymph node dissection is increasingly performed on patients with high-risk prostate cancer. There are few studies on quality of life (QOL) outcomes following RARP for high-risk disease. We used a validated QOL questionnaire to evaluate of the long-term morbidity associated with this treatment paradigm.
METHODS:
Men included in our institutional IRB approved prostatectomy database are asked to complete the Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire preoperatively and at each follow-up visit. We queried the database for all patients who underwent RARP as initial therapy for D’Amico high-risk prostate cancer between 2/2004-11/2011. Patients were excluded if they had undergone previous radiotherapy or androgen deprivation therapy. Questionnaire scores were aggregated into a composite index score of 0-100, with 100 representing the most favorable score for the following domains: urinary function (UF), bowel health (BH), hormonal function (HF), and sexual function (SF). Index scores were stratified by nerve-sparing (NS) status. Linear regression models and analysis of variance were used for statistical comparisons.
RESULTS:
A total of 277 patients met inclusion criteria. Median age at surgery was 62; median follow-up interval was 11.7 months (max: 145 months); and a mean of 4.4 questionnaires were completed per patient. Eighty-one men underwent a bilateral NS procedure, 81 a unilateral NS procedure, and 115 a non-NS procedure.
Mean index scores on the UF, HF, and SF domains changed significantly from baseline (p<0.01 for all), while mean index scores on the BH domain did not change significantly (p=0.234). At 2 years, nerve-sparing status was associated with a statistically significant improvement in scores in the SF domain only, with patients undergoing unilateral (p=0.01) or bilateral NS (p<0.01) reporting higher scores than non-NS patients.
CONCLUSIONS:
QOL outcomes based on EPIC-26 scores for patients undergoing RARP for high-risk prostate cancer were similar to those of lower-risk cohorts in previously published studies. Randomized comparisons of QOL outcomes between treatment modalities for high-risk patients are needed to optimize treatment strategies.