Decision Regret after Radical Prostatectomy Does Not Depend upon Surgical Approach: 6-Year Follow-Up of a Large German Cohort Undergoing Routine Care.

Numerous studies have compared outcomes of open (ORP) and robotic-assisted radical prostatectomy (RARP), but only one study focused on patient satisfaction and regret. Our study aimed to evaluate intermediate-term decision regret after ORP and RARP.

The "HAROW" study analyzed localized prostate cancer patient treatments (≤T2c N0 M0) in Germany from 2008 to 2013. For 1260 patients after retropubic ORP or RARP, we collected a intermediate-term follow-up.

The response rate was 76.8% (936/1218). Four hundred four patients underwent RARP, and 532 underwent ORP. RARP patients showed more self-determined behavior; they reported an active role in surgical decision making (RARP 39% vs. 24% ORP, p<0.001) and surgical approach (RARP 52% vs. 18% ORP, p<0.001). RARP patients actively participated treating hospital selection (RARP 25% vs. 11% ORP, p<0.001) used the internet often (RARP 87% vs. 72% ORP, p<0.001), and traveled increased distances (RARP 65 km vs. 40 km ORP, p<0.001). Overall, decision regret was low, with a mean score of 14 ± 19 (0 = no regret; 100 = high regret). Multivariate analysis showed that erectile function (OR 3.2), urinary continence (OR 1.8), freedom of recurrence (OR 1.6), an active role in decision making (OR 2.2), and shorter follow-up time (OR 0.9 per year) were predictive of low decision regret (score<15).

Intermediate-term functional and oncologic outcomes as well as autonomous decision making and follow-up time influenced decision regret after radical prostatectomy. The surgical approach was not associated with intermediate-term decision regret.

The Journal of urology. 2019 Sep 13 [Epub ahead of print]

Martin Baunacke, Maria-Luisa Schmidt, Christer Groeben, Angelika Borkowetz, Christian Thomas, Rainer Koch, Felix K H Chun, Andreas Ihrig, Lothar Weissbach, Johannes Huber

Department of Urology, TU Dresden, Dresden, Germany., Department of Urology, Goethe-University Hospital, Frankfurt/Main, Germany., Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University of Heidelberg, Heidelberg, Germany., Health Research for Men GmbH, gfm, Berlin, Germany.

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