592 QUALITY OF LIFE AFTER ROBOT ASSISTED COMPARED TO OPEN RADICAL PROSTATECTOMY: INITIAL EXPERIENCE IN THE COMMUNITY SETTING

Article Outline

• INTRODUCTION AND OBJECTIVES
• METHODS
• RESULTS
• CONCLUSIONS
• Copyright

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INTRODUCTION AND OBJECTIVES 

Effectiveness and quality of life (QOL) outcomes after robot-assisted radical prostatectomy (RARP) compared to open radical prostatectomy (ORP) were challenged by a recent study (Hu et al JAMA 2009) concluding that QOL after RARP is inferior based on Medicare diagnosis codes used to measure of urinary incontinence and erectile dysfunction (ED). However, Medicare diagnostic coding is an unreliable measure of QOL outcomes, which are better measured by validated questionnaires. We sought to clarify QOL outcome comparison between RARP and ORP by analyzing technique effects on QOL in the CaPSURE prospective, community-based cohort.

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METHODS 

QOL outcomes after RARP compared to ORP were evaluated in the CaPSURE prospective, multi-regional, community–based cohort using the validated UCLA Prostate Cancer Index (PCI), from which the urinary function (UF), urinary bother (UB), sexual function (SF), and sexual bother (SB) scores were calculated. The positive margin rate was also noted for each approach. Eligible patients were those undergoing RARP or ORP from 2005 to 2007, corresponding to the most recent interval when both techniques were used with adequate follow-up duration. Analysis adjusting for age, PSA, Gleason score, clinical stage, and race compared QOL scores after RARP and ORP patients

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RESULTS 

871 men CaPSURE had prostatectomy from 2005 to 2007: (608 ORP at 22 practice sites and 203 RARP at 13 sites); 711 completed HRQOL surveys within 2 years of surgery. The positive margin rate was 22.0% for ORP and 19.2% for RARP, p=0.16). Mean SF, SB, UF, and UB scores were similar at baseline (66, 73, 94, and 88, respectively, for RALP patients; 63, 71, 93, and 88 for ORP patients). QOL Outcomes in these domains over 2 years' follow up were similar between RARP and ORP (Figure). After adjusting for patient baseline and clinical factors, surgical approach (RARP vs. ORP) was not associated with differences in QOL outcome in any domains (p = 0.20 to 0.70).

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CONCLUSIONS 

Urinary and sexual QOL were similar after ORP compared to RARP. Our findings refute the inferior RARP QOL outcomes suggested by others who used unreliable coding data to assess outcome. We find, in contrast, that despite a relatively early experience, RARP can achieve similar QOL outcomes as ORP. To determine how outcomes after RARP will evolve as surgeon experience grows will require more patients and longer follow-up.

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