Robot-assisted radical prostatectomy (RARP) has been rapidly adopted without robust evidence comparing its functional outcomes against laparoscopic radical prostatectomy (LRP) or open retropubic radical prostatectomy (ORP) approaches. This study compared patient-reported functional outcomes following RARP, LRP or ORP.
All men diagnosed with prostate cancer in England during April - October 2014 who underwent radical prostatectomy were identified from the National Prostate Cancer Audit and mailed a questionnaire 18 months after diagnosis. Group differences in patient-reported sexual, urinary, bowel and hormonal function (EPIC-26 domain scores) and generic health-related quality of life (HRQoL; EQ-5D-5L scores), with adjustment for patient and tumour characteristics, were estimated using linear regression.
In all, 2219 men (77.0%) responded; 1310 (59.0%) had RARP, 487 (21.9%) LRP and 422 (19.0%) ORP. RARP was associated with slightly higher adjusted mean EPIC-26 sexual function scores compared with LRP (3·5 point difference; 95% CI: 1.1-5.9, P=0.004) or ORP (4.0 point difference; 95% CI: 1.5-6.5, P=0.002), which did not meet the threshold for a minimal clinically important difference (10-12 points). There were no significant differences in other EPIC-26 domain scores or HRQoL.
It is unlikely that the rapid adoption of RARP in the English NHS has produced substantial improvements in functional outcomes for patients.British Journal of Cancer advance online publication, 18 January 2018; doi:10.1038/bjc.2017.454 www.bjcancer.com.
British journal of cancer. 2018 Jan 18 [Epub ahead of print]
Julie Nossiter, Arunan Sujenthiran, Susan C Charman, Paul J Cathcart, Ajay Aggarwal, Heather Payne, Noel W Clarke, Jan van der Meulen
Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK., Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE, UK., Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK., Department of Oncology, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK., Department of Urology, The Christie, Manchester M20 4BX, UK.