Prostatic fascia-sparing robotic-assisted radical prostatectomy (PFS-RARP) has improved short-term postoperative continence compared to standard prostatectomy (S-RARP) but long-term differences remain unclear.
One hundred two S-RARP followed by 239 PFS-RARPs were performed by a single surgeon. Univariate analyses were performed with t-test, χ2, Wilcoxon rank sum, Fisher exact, and analysis of variance (ANOVA). Regression models analyzed associates of EPIC-CP scores and oncologic outcomes. Cox proportional hazards modeling assessed postoperative continence. Primary outcomes included patient-reported urinary incontinence (UI) via EPIC-CP and continence rates. Secondary outcomes included EPIC-CP scores, positive surgical margins (PSM), and biochemical recurrence (BCR). Perioperative outcomes and time to continence were measured.
Median follow-up for PFS-RARP vs. S-RARP was 26 vs. 65 months. PFS-RARP demonstrated improved EPIC-CP UI and total scores at 24 months. On multivariate analysis, PFS-RARP was associated with improved EPIC-CP UI and total scores through 18 months, but not with PSM or BCR. PFS-RARP had a 39% and 66% reduced risk of incontinence using 0 and 0 to 1 pad-use definitions (HR 0.61, 95% CI 0.39 - 0.95; HR:0.34, 95% CI 0.16 - 0.76). Continence returned faster with PFS-RARP (0 PPD: 91.0 days vs. 261 days, P < 0.001; 0-1 PPD: 32.7 days vs. 171 days, P < 0.001). There were no differences in PSM (35% vs. 25%, P = 0.064). There were more anterior PSM in PFS-RARP vs. S-RARP (47% vs. 26% P = 0.035), but no differences in BCR (16% vs. 22% P = 0.241).
PFS-RARP improves continence and patient-reported QOL up to 24 months postoperatively without compromising oncologic outcomes.
Urologic oncology. 2024 Jan 10 [Epub ahead of print]
Christopher P Dall, J Bradley Mason, Eshrar Choudhury, Belen Mora-Garijo, Jillian Egan, Jim C Hu, Keith J Kowalczyk
Department of Urology, Medstar Georgetown University Hospital, Washington, DC, USA; Department of Urology, Medstar Washington Hospital Center, Washington, DC, USA. Electronic address: ., Department of Urology, Medstar Georgetown University Hospital, Washington, DC, USA; Department of Urology, Medstar Washington Hospital Center, Washington, DC, USA., Georgetown University School of Medicine, Washington, DC, USA., Department of Urology, Massachusetts General Hospital, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Boston, MA, USA., Department of Urology, Weill Cornell Medical Center, New York, NY, USA., Department of Urology, Medstar Georgetown University Hospital, Washington, DC, USA; Department of Urology, Medstar Washington Hospital Center, Washington, DC, USA; Georgetown University School of Medicine, Washington, DC, USA.