Abstract: PD15-05
Sources of Funding: U.S. Department of Defense Prostate Cancer Research Program DOD TIA grant W81XWH-13-2-0074

Introduction

Identifying the optimal surgical approach for patients with localized prostate cancer (PCa) remains controversial due to the lack of robust, long-term, prospective data. We assessed surgical outcomes and changes in patient-reported urinary and sexual quality of life (QOL) over time in patients undergoing open radical prostatectomy (ORP) vs. robot-assisted radical prostatectomy (RARP) in a large, prospective, mostly community-based, nationwide PCa registry.

Methods

Within the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry, we identified patients who underwent radical prostatectomy (RP) between 2004 and 2016 for localized PCa. Demographic and clinicopathologic data and surgical outcomes were compared between ORP vs. RARP groups. Self-reported, validated questionnaires were used to evaluate urinary and sexual QOL at different time points. Repeated measures mixed-models assessed changes in function and bother over time in each domain. Scores were adjusted for surgical approach, time, surgical approach-time interaction, patient age and year at diagnosis, number of comorbidities, clinical Cancer of the Prostate Risk Assessment (CAPRA) score, prostate volume, body mass index at diagnosis, degree of nerve-sparing, and type of clinical site.

Results

In total, we included 1,892 men (n=1,137 ORP; n=755 RARP) in our analysis. The RARP cases reflected the first such cases performed at each CaPSURE site. Men undergoing RARP had more lymph nodes dissected at RP (median 7 vs. 4; p≤0.01 ). CAPRA score, Gleason grade at biopsy and RP, and pathologic T-stage were lower in ORP patients (all p<0.01). In a subset analysis with 1,451 men reporting baseline and follow-up QOL data, ORP patients had higher urinary incontinence (ORP 69±26 vs. RARP 62±27) and bother scores (ORP 75±29 vs. RARP 68±28; both p<0.01) <1 year after RP. Differences in sexual outcomes did not differ between groups, nor did any QOL scores beyond one year.

Conclusions

Most patients experienced changes in urinary and sexual QOL in the first three years following RP. The patterns of change over time were similar between ORP and RARP patients in a community-based cohort, reflecting the initial learning curve with RARP in this population.

Funding

U.S. Department of Defense Prostate Cancer Research Program DOD TIA grant W81XWH-13-2-0074