Validated Prospective Assessment of Quality of Life After Robot-Assisted Laparoscopic Prostatectomy: Beyond Continence and Erections

Continence and erectile function represent major concerns after robot-assistedlaparoscopic prostatectomy (RALP), although the analysis of only these resultsmay underestimate the impact of surgery on quality of life (QoL). The aim of thestudy is to prospectively analyze QoL after RALP according to the validatedEuropean Organization for Research and Treatment of Cancer Quality of LifeQuestionnaire prostate cancer–specific module (EORTC-QLQ-PR25) and C30 andexplore risk factors for the deterioration of QoL after surgery.A total of 584 patients undergoing RALP were prospectively enrolled. QoL wasassessed with the validated EORTC-QLQ-PR25 and C30. Differences across QoL itemswere assessed via Wilcoxon rank-sum test and associations between risk factorsand QoL scores were tested via univariate and multivariate linear regressionanalyses.All items of the PR25 questionnaire showed a significant deterioration at 1 monthafter RALP and began to normalize 3 months after surgery. At 24 monthsfollow-up, urinary, bowel, and sexual activity scores were not significantlydifferent from preoperative scores, while incontinence aid, treatment-relatedsymptoms, and sexual functioning remained significantly worse. Preoperativesexual activity was more important in determining 3-month sexual outcomes thanpreoperative 5-item version of the International Index of Erectile Function(IIEF-5) or nerve-sparing approach. An overall return to preoperative QoL wasregistered at 3 months after RALP in global and physical QoL, and mostimportant, global, physical, social, and role-functioning QoL scores wereimproved at 12 and 24 months compared to preoperative scores.In this prospective study, detailed data on QoL are reported via the EORTC-PR25and C30 questionnaires. While urinary, bowel, and sexual activity scores returnto baseline values 24 months after surgery, incontinence aid, treatment-relatedsymptoms, and sexual functioning may remain significantly deteriorated. Largerstudies are needed to validate these findings.