Exploring pathways towards improving patient experience of robot‐assisted radical prostatectomy (RARP): assessing patient satisfaction and attitudes

Reynolds, B.; Bulsara, Caroline; Zeps, Nikolajs; Codde, Jim; Lawrentschuk, Nathan; Bolton, Damien; Vivian, Justin

doi:10.1111/bju.14226

Cited by 35 publications

(35 citation statements)

References 38 publications

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“…3B). While Reynolds et al [34] reported high overall patient satisfaction post RARP, mainly as result of peri-operative education, this data supports the evidence that further satisfaction may be attributable to clinical improvement especially in those patients with moderate to severe LUTS pre-surgery.…”

Section: Discussionsupporting

confidence: 62%

Improved lower urinary tract symptoms after robot‐assisted radical prostatectomy: implications for survivorship, treatment selection and patient counselling

et al. 2019

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ObjectiveTo assess changes in lower urinary tract symptoms (LUTS) and quality of life (QoL) after robot-assisted radical prostatectomy (RARP). Patients and MethodsA prospectively curated database of 1917 consecutive RARPs undertaken over an 8-year period from January 2009 to January 2017 was assessed. Preoperative information including age, prostate-specific antigen (PSA) level, body mass index (BMI), International Prostate Symptom Score (IPSS) and QoL score was collected, with IPSS and QoL score compared between baseline (preoperatively) and 12 months post-surgery. ResultsOf the 1917 patients who underwent RARP, 1470 with complete data were included in the analysis. Their mean AE SD age, prostate weight and BMI were 62 (AE6.7) years, 51 (AE17.6) g, and 28 kg/m 2 , respectively. Overall, 57% of patients reported an improved IPSS score, whilst 76% reported an IPSS of ≤7 postoperatively. A total of 41% of patients reported an improved QoL and 90.3% of patients with severe preoperative LUTS (IPSS 20-35) demonstrated clinically improved LUTS at 1 year post RARP. The post-RARP mean IPSS in the present study was lower than those reported in the existing post-radiotherapy literature, especially in patients with moderate to severe baseline LUTS (IPSSs ≥ 8). ConclusionsAt 12 months post RARP, most patients reported improved overall LUTS and QoL, with the greatest benefit seen in those patients with a high pre-RARP IPSS. This has implications for treatment selection and preoperative counselling in men being offered active treatment for their prostate cancer. Further analyses of specific IPSS domains and longer followup are needed. KeywordsInternational Prostate Symptom Score, lower urinary tract symptoms, prostate cancer, quality of life, robot-assisted radical prostatectomy, survivorship Abbreviations: QoL, quality of life; RARP, robot-assisted radical prostatectomy; PCa, prostate cancer.

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Section: Discussionsupporting

confidence: 62%

Improved lower urinary tract symptoms after robot‐assisted radical prostatectomy: implications for survivorship, treatment selection and patient counselling

et al. 2019

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“…Several cohorts of older men undergoing robot‐assisted RP have now been published showing short‐ and long‐term outcomes that are similar or only slightly inferior to those shown in younger men . Indeed, patients report high satisfaction with robot‐assisted RP (97.6%) and are likely to recommend this treatment (91.1%), which may further account for patient choice in this population . Furthermore, side effects from RT can result in significant morbidity for patients, including local toxicity resulting in emergency admissions that may require surgery (clot evacuation, urethral dilatation) or definitive reconstructive surgery , as well as systemic toxicity from androgen deprivation therapy, which may further deter men from this choice of treatment.…”

Section: Discussionmentioning

confidence: 99%

A contemporary, nationwide analysis of surgery and radiotherapy treatment for prostate cancer

et al. 2019

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ObjectiveTo characterize national clinical practice trends in the treatment of prostate cancer (PCa) in Australia. Patients and MethodsPopulation-level data were extracted from existing Medicare Benefits Schedule data for radical prostatectomy (RP) and brachytherapy (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016), as well as external beam radiotherapy (EBRT; 2012-2016). Treatment rates were calculated relative to whole and PCa populations among privately treated patients. Overall age-related and geographical trends were analysed. ResultsThe use of RP and low-dose-rate (LDR) brachytherapy increased between 2002 and 2009, but subsequently decreased to 124 and 6.9 per 100 000 men, respectively, in 2016. More dramatic decreases were observed for men aged <65 years. From 2012, rates of RP (15% drop) and LDR brachytherapy (58% drop) decreased, while the use of EBRT remained steady, falling by 5% to 42 per 100 000 men in 2016. Overall treatment increased in the age group 75-84 years, with the rate of RP increasing by 108%. ConclusionNational claims data indicate there has been a reduction in PCa treatment since 2009, which is mostly attributable to a reduction in the treatment of younger patients and reduced use of brachytherapy. RP is most commonly used and its use is rising in men aged >65 years.

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“… and Reynolds et al. . Transparent and continuous monitoring and reporting (by use of patient‐reported outcomes, standardized outcome measures and data collection by independent data managers) should be the way forward to improve the quality of healthcare for our patients.…”

Section: Discussionmentioning

confidence: 99%

Prostate cancer in 432 men aged <50 years in the prostate‐specific antigen era: a new outlook

et al. 2018

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share equal senior contribution. ObjectiveTo evaluate the clinical presentation and treatment outcomes of prostate cancer (PCa) in 432 consecutive patients aged < 50 years in the prostate-specific antigen (PSA) era. MethodsRetrospective analysis was performed on all patients with PCa (14 570) from the years 1994 to 2017. A total of 432 consecutive patients aged < 50 years were identified. The patients were stratified by D'Amico risk groups, and their clinical presentation and treatment outcomes were analysed. The rates of biochemical recurrence after surgery were compared with the D'Amico prediction model as well as with older propensity-score-matched patients. The surgical pathology results in patients undergoing active surveillance (AS) were compared with those of low-risk patients who underwent immediate surgery. ResultsA total of 44%, 42% and 13% of patients harboured low-risk, intermediate-risk and high-risk PCa, respectively. Their median age was 47 years and a positive family history of PCa was reported in 39.1%. Clinical stage was T1 in 65.5% and T2 in 30.0% of patients, and 2.0% of patients had metastatic disease at presentation. Radical prostatectomy (RP) was performed in 78.4% of patients (n = 339) and the biochemical recurrence rates were 7.8% (low-risk), 15.3% (intermediate-risk) and 23.3% (high-risk) at 5 years postsurgery. These rates were lower than expected according to the D'Amico prediction model or when compared with older matched patients. A total of 74 patients with low-risk PCa underwent AS and only 17.6% (n = 13) required radical treatment after a median follow-up of 46 months. The surgical pathology results in patients undergoing ASdid not differ significantly from patients with low-risk PCa who underwent immediate surgery (positive surgical margins [P = 0.145], tumour volume [P = 0.257] or seminal vesicle involvement [P = 0.100]). Of the present cohort, only 0.4% died from PCa during a median follow-up of 65 months. ConclusionsThe clinical presentation and prognosis of young patients has changed dramatically during the PSA era. Patients nowadays present with lower-risk disease that can be treated adequately, with reassuring biochemical recurrence rates at 5 years postsurgery. AS appears to be safe in patients with low-risk. PCa.

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Exploring pathways towards improving patient experience of robot‐assisted radical prostatectomy (RARP): assessing patient satisfaction and attitudes

Cited by 35 publications

References 38 publications

Improved lower urinary tract symptoms after robot‐assisted radical prostatectomy: implications for survivorship, treatment selection and patient counselling

Improved lower urinary tract symptoms after robot‐assisted radical prostatectomy: implications for survivorship, treatment selection and patient counselling

A contemporary, nationwide analysis of surgery and radiotherapy treatment for prostate cancer

Prostate cancer in 432 men aged <50 years in the prostate‐specific antigen era: a new outlook

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