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BACKGROUND: Previously published reports on long-term health-related quality of life (QOL) outcomes after prostatectomy have included few high-risk patients. Robotic prostatectomy is increasingly being performed on patients with high-risk disease. We used a validated QOL questionnaire to compare outcomes in our D’Amico low-, intermediate-, and high-risk cohorts.
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 subsequent visit. We queried the database for all patients who underwent robot-assisted radical prostatectomy (RARP) between January, 2004 and December, 2011. Patients were included if they completed at least one EPIC-26 survey. Survey results were converted to scores from 0-100, and aggregated as previously described into the following indices: urinary function (UF), bowel health (BH), hormonal function (HF), and sexual function (SF). The UF index was further stratified by urinary incontinence (UI) and urinary obstruction (UO) sub-domains. Average survey scores were calculated at baseline, 0-6, 6-12, 12-24, and 24-48 months postoperatively. For patients who completed more than one survey during any one of the time frames, the later survey was used. Analysis of variance was used to compare the indices of the three different risk groups at the beginning and end of the study.
RESULTS: 1674 patients completed at least one survey during the course of their care. Of these, 743 were low-risk, 742 were intermediate-risk, and 189 were high-risk. Baseline demographics were examined for the 3 risk groups, including age, race, preoperative Gleason score, and clinical stage. Mean age at surgery was 60.3±6.5 years. Average age for patients in the low-, intermediate, and high-risk groups respectively was 58.9, 61.2, and 62.6. 1214 underwent RARP with bilateral nerve-sparing, while 295 had unilateral nerve-sparing, and 158 had no nerve sparing. Gleason sum distribution was: 6- 819 patients, 7- 708 patients, ≥8- 146 patients. At baseline, UF scores for low-, intermediate-, and high-risk patients respectively were 90.4, 90.9, and 88.1 (p=0.17); UI scores were 94.3, 93.8, and 92.7 (0.78); UO scores were 88.1, 89.2, and 85.4 (0.09); BH scores were 97, 97.1, and 96 (0.68); HF scores were 94.9, 94, and 94.5 (0.14); and SF scores were 76.5, 70.9, and 60.6 (<0.01). At 12-24 months, UF scores for low-, intermediate-, and high-risk patients respectively were 88.3, 87.4, and 84.3 (p=0.22); UI scores were 82.3, 80.6, and 76.3 (0.07); UO scores were 94.6, 94.3, and 92.9 (0.04); BH scores were 96.8, 96.7, and 95 (0.4); HF scores were 93.8, 94.5, and 91.6 (0.15); and SF scores were 56.3, 44.2, and 33.8 (<0.01).
CONCLUSIONS:QOL measures showed significant difference in SF indices at baseline between low-, intermediate-, and high-risk prostate cancer cohorts. Long-term differences in QOL were seen in UF, UO, BH, and SF indices. Randomized comparisons of QOL outcomes between treatment modalities for high risk patients are needed to optimize treatment strategies.