Majority of patients do not regret robotic RP

The majority of patients undergoing robot-assisted laparoscopic prostatectomy surgery for localized prostate cancer do not regret their treatment decision, according to a recent study.

Analysis indicates the primary factors contributing to postoperative quality of life, and therefore satisfaction or dissatisfaction with treatment choice, are preoperative and postoperative sexual potency and urinary control.

The study, which was published in the Journal of Urology (2012; 188:2213-8), included 953 consecutive prostate cancer patients treated with robot-assisted laparoscopic prostatectomy performed by senior author David Samadi, MD, of Mount Sinai Medical Center, New York.

At a median of 11.1 months after robotic surgery, 74% of patients completed questionnaires regarding quality of life and treatment decisional regret. Of these patients, 88% reported satisfaction with their decision to have RALP.

In this study, Dr. Samadi and colleagues sought to define specific factors impacting patient decisional regret following robotic prostatectomy for localized prostate cancer. Their analysis focused on the relationship between independent baseline status and quality of life after surgery; namely, patient age and erectile and urinary function before and after surgery.

"It is encouraging that nearly a year after surgery, the majority of my patients are satisfied with their treatment choice and quality of life," Dr. Samadi said. "I believe these findings highlight the importance of pre-op counseling; working one-on-one with patients and their partners to provide a realistic assessment of before and after functions."

Patient-reported data indicated that those with preexisting erectile dysfunction have greater difficulty with sexual potency after surgery. In terms of regret, however, men with superior preoperative erectile function were more bothered by postoperative sexual issues than those already experiencing some degree of erectile dysfunction. Additionally, patients with severe baseline lower urinary tract symptoms were more regretful after surgery, despite their preexisting urinary problems.

"What we found is that patient satisfaction with robotic prostate surgery depends on a range of pre- and postoperative variables. This reinforces the need for patient-specific treatment counseling before surgery and a continuing doctor-patient relationship during post-surgery rehabilitation,” Dr. Samadi said.