Abstract: PD18-08
Sources of Funding: PROST-QA Consortium Funded by National Institutes of Health Grants R01 CA95662, RC1 CA146596, and RC1 EB011001. The Multicentric Spanish Group of Clinically Localized Prostate Cancer was supported by a grant from Instituto de Salud Carlos III FEDER: Fondo Europeo de Desarrollo Regional (PI13/00412). Dr. Chang is supported by a Urology Care Foundation Research Scholar Award and the Martin and Diane Trust Career Development Chair in Surgery.

Introduction

Comparisons of robot-assisted laparoscopic (RALP) and open radical prostatectomy (ORP) are often limited by retrospective approaches, non-patient-reported health-related quality of life (HRQOL) evaluations, or single center/surgeon analyses. Herein we present a prospective, multicenter comparison of RALP and ORP.

Methods

We evaluated men from two prospective, multicenter, longitudinal studies treated from 2003-2012 with a pre-specified analytic goal of comparing RALP (n=549) and ORP (n=545). Subjects completed EPIC-26 HRQOL questionnaires at pre-treatment, 2, 6, 12, and 24 months post-operatively, with follow-up compliance >85%. We used univariate mixed models with cohort as a random effect to assess differences in baseline demographic and cancer characteristics, and the chi-square test to evaluate differences in surgical and peri-operative outcomes between surgical approaches. We evaluated for predictors of HRQOL domain score changes over time using semi-parametric generalized estimated equation modeling with compound symmetrical correlation structure, controlling for nesting within cohort.

Results

We found no significant differences in demographics, cancer characteristics, pathologic T stage, or margin status between surgical approaches. ORP subjects were more likely than RALP subjects to undergo lymphadenectomy (89% vs 47%; p<0.01) and nerve sparing (94% vs 89%; p<0.01). RALP subjects had less mean intraoperative blood loss (192 vs 805 mL; p<0.01), shorter mean hospital stay (1.6 vs 2.1 days; p<0.01), and fewer blood transfusions (1% vs 4%; p<0.01), wound infections (2% vs 4%; p=0.02), other infections (1% vs 4%; p<0.01), deep vein thrombosis (DVT; 0.5% vs 2%; p=0.04), and unplanned catheterizations (3% vs 7%; p<0.01) than ORP subjects. RALP subjects reported less surgical pain (p=0.04), less pain interference with activity (p<0.01) and higher incision satisfaction (p<0.01). Surgical approach was not a significant predictor of HRQOL change over time in any of the five EPIC-26 HRQOL domains.

Conclusions

In this multicenter, prospective evaluation of ORP and RALP, surgical approach was not a significant predictor of post-surgical HRQOL change. RALP subjects had superior incisional/pain outcomes, shorter hospital stays, and fewer post-surgical complications such as blood transfusions, infections, DVTs, and unplanned catheterizations. These results should help guide treatment counseling and be integrated into future cost analyses.

Funding

PROST-QA Consortium Funded by National Institutes of Health Grants R01 CA95662, RC1 CA146596, and RC1 EB011001. The Multicentric Spanish Group of Clinically Localized Prostate Cancer was supported by a grant from Instituto de Salud Carlos III FEDER: Fondo Europeo de Desarrollo Regional (PI13/00412). Dr. Chang is supported by a Urology Care Foundation Research Scholar Award and the Martin and Diane Trust Career Development Chair in Surgery.