Patient-reported outcomes after open and robotic radical prostatectomy: a New Zealand registry study.

Abstract

Our objective was to compare functional outcomes between open radical prostatectomy (ORP) and robotic-assisted laparoscopic prostatectomy (RALP) in New Zealand. We analysed responses from men in the Prostate Cancer Outcome Registry of New Zealand (PCOR-NZ) who underwent ORP or RALP as primary treatment for prostate cancer between January 2016 and December 2024. We included men who completed an Expanded Prostate Cancer Index - 26 (EPIC-26) patient-reported outcome measure (PROM) questionnaire either at baseline, 12 months after radical prostatectomy or both. EPIC-26 scores range from 0 to 100 (100 = best score). Established thresholds assessed minimal clinically important differences; urinary incontinence (6-9 points), urinary obstruction (5-7 points), bowel (4-6 points), sexual (10-12 points) and hormonal (4-6 points). Mean differences were calculated using multivariate analysis to adjust for age, prostate-specific antigen and International Society of Urological Pathology grade. Additional analyses assessed daily pad usage and patient-reported sexual function. Of the 4889 men who completed a questionnaire, 2844 (58.1%) underwent ORP and 2045 (41.8%) underwent RALP. PROM completion rates were 52.3% at baseline and 78.8% at 12 months after treatment. Patients who underwent RALP had higher post-treatment PROM scores in all domains. Adjusted mean differences for urinary incontinence (6.9 points, 95% confidence interval 4.6-9.2 P < 0.001) and sexual (11.4 points, 95% confidence interval 9.1-13.7, P < 0.001) domains were above the threshold for minimal clinically important difference. Urinary obstruction, bowel and hormonal domains did not reach clinical significance. At 12 months, RALP had a higher rate of zero pads/day usage (65.1% vs 54.4% P < 0.001) and lower two or more pads/day usage (3.9% vs 10.0% P < 0.001). More men in the RALP group reported a 'good' to 'very good' sexual function at 12 months (13.7% vs 5.3%, P < 0.001). RALP is associated with higher PROMs across all EPIC-26 domains, with clinically meaningful benefit in sexual function, urinary incontinence and reduced incontinence pad usage at 12 months.