Patient-reported outcomes after open radical prostatectomy, laparoscopic radical prostatectomy and permanent prostate brachytherapy

Abstract

Objective To assess patient-reported outcomes after open radical prostatectomy, laparoscopic radical prostatectomy and permanent prostate brachytherapy. Methods patient-reported outcomes were evaluated using Expanded Prostate Cancer Index Composite scores at baseline and 1, 3, 6, 12 and 36 months after treatment, respectively, using differences from baseline scores. Results Urinary function was the same in the three groups at baseline, but worse after surgery than after permanent prostate brachytherapy until 12 months, and similar after open radical prostatectomy and permanent prostate brachytherapy and better than after laparoscopic radical prostatectomy at 36 months. Urinary bother was significantly worse at 1 month after surgery, but better after open radical prostatectomy than after permanent prostate brachytherapy and laparoscopic radical prostatectomy at 3 months, after which symptoms improved gradually in all groups. Obstructive/irritative symptoms were worse after permanent prostate brachytherapy than after open radical prostatectomy at 36 months, and worse after laparoscopic radical prostatectomy until 6 months. Urinary incontinence was worse after surgery, particularly after 1 month. This symptom returned to the baseline level at 12 months after open radical prostatectomy, but recovery after laparoscopic radical prostatectomy was slower. Bowel function after permanent prostate brachytherapy was significantly worse than after surgery at 1 month and this continued until 6 months. Bowel bother was slightly worse at 3 and 6 months after permanent prostate brachytherapy compared to these time points after surgery. Conclusion Urinary function and bother were worst after laparoscopic radical prostatectomy, especially in the early postoperative phase, whereas urinary obstructive/irritative symptom, bowel function and bother were worse after permanent prostate brachytherapy. These findings are useful and informative for the treatment of patients with prostate cancer.

Quality of life in patients who underwent robot‐assisted radical prostatectomy compared with those who underwent low‐dose‐rate brachytherapy

“…In the present study, bowel QOL deteriorated more in patients who underwent LDR‐BT versus RARP. This result is consistent with those of other reports 3,12,19 . Blanchard et al 3 reported that LDR‐BT alone worsened bowel QOL compared with nerve‐sparing RARP.…”

“…In the present study, sexual QOL was significantly worsened in the RARP group versus the LDR‐BT group. The deterioration of sexual QOL caused by LDR‐BT and radical prostatectomy has been reported in other studies 3,19,20,23 . Mullins et al 24 reported that patients treated with radical prostatectomy with or without nerve sparing had worsened sexual QOL compared with those who underwent brachytherapy.…”

Patient-reported outcomes after robot-assisted radical prostatectomy and institutional learning curve for functional outcomes

“…found that physician ratings of symptoms do not correlate well with PROs, and that disagreement between physician and patient ratings did not decrease over time. [ 5 ] We have reported PROs for ORP compared to LRP,[ 6 , 7 ] with the finding that ORP was better for urinary incontinence. However, we have not examined the outcomes of RARP, and there are few reports on this surgery using PROs in Japan.…”

The use of advanced imaging in guiding the further investigation and treatment of primary prostate cancer

“…The treatment options are multifaceted and include prostatectomy, radiation therapy, hormonal therapy, chemotherapy, or a combination of these [ 5 – 7 ]. While a whole-gland treatment approach shows good oncological results, it may also have life-altering side effects such as incontinence, impotence, and infection [ 8 ]. As the majority of PC are localized within the prostate gland [ 9 ], minimal invasive local treatment approaches have been gaining in interest and popularity as the adverse events reported are low while having good oncological outcome [ 10 ].…”