The comparison of post-treatment quality of life after at least two years of follow-up (≥ 24 months) between robotic radical prostatectomy and radiotherapy for intermediate-risk localized prostate cancer

TL;DR

This study compares long-term quality of life after robotic prostate surgery and radiation therapy for prostate cancer.

Contribution

The study provides a novel comparison of quality of life outcomes after two years of follow-up between robotic prostatectomy and radiotherapy for intermediate-risk prostate cancer.

Findings

Patients who had robotic prostatectomy reported better bowel and hormonal outcomes after two years.

Radiotherapy patients had better sexual function but worse urinary and bowel symptoms.

Overall satisfaction with treatment was higher in the robotic prostatectomy group.

Abstract

Robot-assisted laparoscopic radical prostatectomy (RALRP) and intensity-modulated radiotherapy (IMRT) are the main curative options for localized prostate cancer (PCA). However, both may significantly affect patients’ quality of life (QoL).

To retrospectively compare post-treatment QoL after at least 24 months of follow-up between bladder-neck- and nerve-sparing RALRP and IMRT in patients with intermediate-risk localized PCA.

A total of 164 patients treated between October 2016 and May 2023 were analyzed (104 RALRP; 60 IMRT). QoL was evaluated using the Expanded Prostate Cancer Index Composite (EPIC-2002). Urinary, bowel, sexual, and hormonal domains were compared using appropriate statistical tests .

Baseline demographics were similar between groups. The mean age was 68.82 ± 6.72 years in the RALRP group and 68.89 ± 7.81 years in the IMRT group. IMRT patients reported better sexual function (p < 0.05), but this advantage was counteracted by hormonal side effects due to androgen deprivation therapy (ADT). Urinary continence was comparable (p > 0.05), whereas irritative urinary symptoms were more common in IMRT (p < 0.001). Bowel function and overall satisfaction were significantly better in RALRP (both p < 0.001).

After ≥ 24 months of follow-up, RALRP provided superior bowel and hormonal outcomes, while IMRT yielded slightly better sexual function scores. Overall satisfaction favored RALRP.