In this retrospective study, our objective was to report longitudinal changes in AUA symptom scores (AUAss) and QoL (quality of life) in 666 men presenting for RARP with Mild (0-7), Moderate (8-19), or Severe (20-35) symptoms. A secondary objective was to provide assistance to patients and surgeons during the preoperative counseling period regarding achievable short and long-term (5 year) outcomes after surgery.
Our results demonstrate that although men with mild AUAss preoperatively experience short term increases in AUAss at 3 months, they remain statistically and clinically unchanged long-term with respect to their baseline symptom scores and urinary QoL. However, men with moderate preoperative LUTS experience urinary symptom improvements of 7.5 points and men with preoperative severe LUTS experience the largest improvements of 16.4 points. Quality of life scores in moderate and severe LUTS men improved from 2.4 (Mostly Satisfied) and 4.0 (Mostly Dissatisfied) to scores of 1.4 (Pleased) and 2.0 (Mostly Satisfied) at 5 years, respectively.
An important clinical implication is that prostate cancer patients with moderate and severe LUTS should be counseled regarding the potential QoL benefits and improved AUAss after prostatectomy [2, 3]. Generally, these men can expect to be ‘Pleased’ to ‘Mostly Satisfied’ regarding their urinary quality of life after surgery. This is noteworthy as other treatment options either do not relieve symptoms (active surveillance) or potentially exacerbate symptoms (radiation). Further support regarding the relief of obstruction after RARP has been confirmed with improved urinary peak flow rates across all 3 LUTS groups in the same cohort of men [4]. Thus, men considering the various treatment options for prostate cancer should be counseled regarding the benefits of RARP beyond cancer control.
Written by: Adam Gordon
References:
- Gordon A, Skarecky D, Osann K, Eichel L, Dhaliwal H, Morales B, Ahlering T, Quantification of Long Term Stability and Specific Relief of Lower Urinary Tract Symptoms (LUTS) after Robot-Assisted Radical Prostatectomy, Urology (2016), http://dx.doi.org/doi: 10.1016/j.urology.2016.03.028.
- Prabhu V, Taksler GB, Sivarajan G, Laze J, Makarov DV, Lepor H. Radical prostatectomy improves and prevents age dependent progression of lower urinary tract symptoms. J Urol 2014; 191: 412-7.
- Gordon A, Skarecky DW, Ahlering T. Long-term outcomes in severe lower urinary tract symptoms in men undergoing robotic-assisted radical prostatectomy. Urology 2014; 84: 826-31.
- Skarecky D, Gordon A, Babaian KN, Dhaliwal H, Morales B, Ahlering TE. Analysis of Improved Urinary Peak Flow Rates After Robot-Assisted Radical Prostatectomy. J Endourol 2015; 29: 1152-8.