Patients Regret Their Choice of Therapy Significantly Less Frequently after Robot-Assisted Radical Prostatectomy as Opposed to Open Radical Prostatectomy: Patient-Reported Results of the Multicenter Cross-Sectional IMPROVE Study

Abstract

Patient’s regret (PatR) concerning the choice of therapy represents a crucial endpoint for treatment evaluation after radical prostatectomy (RP) for prostate cancer (PCA). This study aims to compare PatR following robot-assisted (RARP) and open surgical approach (ORP). A survey comprising perioperative-functional criteria was sent to 1000 patients in 20 German centers at a median of 15 months after RP. Surgery-related items were collected from participating centers. To calculate PatR differences between approaches, a multivariate regressive base model (MVBM) was established incorporating surgical approach and demographic, center-specific, and tumor-specific criteria not primarily affected by surgical approach. An extended model (MVEM) was further adjusted by variables potentially affected by surgical approach. PatR was based on five validated questions ranging 0–100 (cutoff >15 defined as critical PatR). The response rate was 75.0%. After exclusion of patients with laparoscopic RP or stage M1b/c, the study cohort comprised 277/365 ORP/RARP patients. ORP/RARP patients had a median PatR of 15/10 (p < 0.001) and 46.2%/28.1% had a PatR >15, respectively (p < 0.001). Based on the MVBM, RARP patients showed PatR >15 relative 46.8% less frequently (p < 0.001). Consensual decision making regarding surgical approach independently reduced PatR. With the MVEM, the independent impact of both surgical approach and of consensual decision making was confirmed. This study involving centers of different care levels showed significantly lower PatR following RARP.

Robot‐assisted radical prostatectomy in Aotearoa New Zealand: equity, quality, and workforce

“…The proportion of RARP increased to 85% in the United States in 2013, 1 93% in England in 2018, 2 and 65% in Australia in 2019 3 . Similar trends have been observed in other advanced economies 4–6 …”

“…3 Similar trends have been observed in other advanced economies. [4][5][6] North Shore Hospital is the only public hospital in Aotearoa New Zealand (AoNZ) with a da Vinci Surgical System (dVSS) (Intuitive Surgical, Sunnyvale, California, USA), and its first RARP was performed in late 2021. Figure 1 outlines the trends for prostatectomy and new prostate cancer registrations in AoNZ from 2010 to 2020 using anonymous procedure-only data from the AoNZ distributor of the dVSS (Device Technologies, Auckland, New Zealand), the National Minimum Dataset for hospital events (National Collections and Reporting, Manat u Hauora, Ministry of Health) and publicly available new prostate cancer registrations from the New Zealand Cancer Registry.…”

Patient Benefits of Radical Prostatectomy in Certified Prostate Cancer Centers: Comparative Results from the Multicenter IMPROVE Study

“…SUI is a highly important outcome parameter for patients' quality of life after RP. Our study group has previously demonstrated an association between SUI and a threefold increased presence of critical DR after RP [25]. While no significant difference in postoperative SUI was observed between CCs and nCCs in the current study, patients who underwent RARP experienced significantly less SUI (OR 0.39; p < 0.001) compared to those treated with ORP or LRP.…”

“…These include the establishment of a structured network among specialized departments, transferring doctors, encounter groups, and the clinic. Additionally, supportive measures such as psycho-oncological support, outreach services, and rehabilitation programs must be provided for the patients [21]. To enhance surgical outcomes, oncological criteria such as the annual caseload of RPs, PSM rate, and NS rate are evaluated.…”

Impact of patients' health insurance status on the type of radical prostatectomy for localized prostate cancer in Germany: An observational analysis based on the multicentric IMPROVE study

“…In this study, 20 urological clinics in Germany were requested to report data of their most recent consecutive 50 radical prostatectomies in 2021 (in addition to clinical and histopathological criteria, demographic and functional aspects of patients were assessed using a questionnaire). [3][4][5] Among the initially contacted 1,000 patients, a response rate of 75% was achieved.…”