Impact of Surgical Approach on Patient-Reported Outcomes after Radical Prostatectomy: A Propensity Score-Weighted Analysis from a Multicenter, Prospective, Observational Study (The Pros-IT CNR Study).

To report health-related quality of life outcomes as assessed by validated patient-reported outcome measures (PROMs) after radical prostatectomy (RP). -Methods: This study analyzed patients treated with RP within The PROState cancer monitoring in Italy, from the National Research Council (Pros-IT CNR). Italian versions of Short-Form Heath Survey and university of California los Angeles-prostate cancer index questionnaires were administered. PROMs were physical composite scores, mental composite scores and urinary, bowel, sexual functions and bothers (UF/B, BF/B, SF/B). Baseline unbalances were controlled with propensity scores and stabilized inverse weights; differences in PROMs between different RP approaches were estimated by mixed models.

Of 541 patients treated with RP, 115 (21%) received open RP (ORP), 90 (17%) laparoscopic RP (LRP) and 336 (61%) robot-assisted RP (RARP). At head-to-head -comparisons, RARP showed higher 12-month UF vs. LRP (interaction treatment * time p = 0.03) and 6-month SF vs. ORP (p < 0.001). At 12-month from surgery, 67, 73 and 79% of patients used no pad for urinary loss in ORP, LRP and RARP respectively (no differences for each comparison). Conversely, 16, 27 and 40% of patients declared erections firm enough for sexual intercourse in ORP, LRP and RARP respectively (only significant difference for ORP vs. RARP, p = 0.0004).

Different RP approaches lead to significant variations in urinary and sexual PROMs, with a general trend in favour of RARP. However, their clinical significance seems limited.

Urologia internationalis. 2019 Feb 07 [Epub ahead of print]

Alessandro Antonelli, Carlotta Palumbo, Marianna Noale, Angelo Porreca, Stefania Maggi, Claudio Simeone, Pierfrancesco Bassi, Filippo Bertoni, Sergio Bracarda, Michela Buglione, Giario Natale Conti, Renzo Corvò, Mauro Gacci, Vincenzo Mirone, Rodolfo Montironi, Luca Triggiani, Andrea Tubaro, Walter Artibani, Pros-IT CNR study group

Urology Unit, ASST-Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, ., Urology Unit, ASST-Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy., Neuroscience Institute, Section of Padua, Aging Branch, National Research Council of Italy, Padua, Italy., Urology Unit, Policlinico di Abano Terme, Padua, Italy., Department of Urology, Catholic University of Rome, Policlinico Gemelli, Rome, Italy., Prostate Group of AIRO, Italian Association for Radiation Oncology, Milan, Italy., Medical Oncology Unit, Azienda USL Toscana Sud-Est, Istituto Toscano Tumori, Arezzo, Italy., Radiation Oncology Unit, Spedali Civili Hospital of Brescia, University of Brescia, Brescia, Italy., Urology Unit, Azienda Socio-Sanitaria Territoriale Lariana, Sant'Anna Hospital, Como, Italy., Radiation Oncology Unit, IRCCS San Martino, Genoa, Italy., Urology Unit, Careggi Hospital, University of Florence, Florence, Italy., Urology Unit, Università Federico II, Naples, Italy., Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy., Urology Unit, Sant'Andrea Hospital, University of Rome "La Sapienza", Rome, Italy., Urology Unit, Azienda Ospedaliera Universitaria integrata di Verona, Verona, Italy.