Presentation Authors: Wout Devlies*, Leuven, Belgium, Greet De Coster, Nancy Van Damme, Thierry Roumeguère, Thierry Quakels, Brussels, Belgium, Ben Van Cleynenbreugel, Leuven, Belgium, Peter Dekuyper, Filip Ameye, Ghent, Belgium, Wouter Everaerts, Steven Joniau, Leuven, Belgium
Introduction: Robot assisted radical prostatectomy (RARP) is in many countries the standard surgical treatment option in intermediate and high risk localised prostate cancer. High quality prospective data investigating factors predicting postoperative Quality of Life (QoL) and functional outcomes after RARP is inexistent. We unravelled different predicting factors using the Be-RALP database, a Belgian prospective multicentre database.
Methods: 9235 high and low/intermediate risk patients, from 2009-2016, were matched 1:1 using coarsened exact matching with age, year of surgery, nerve-sparing and centre size as matching criteria. Age, year of surgery, cancer risk group, hospital volume, post-operative radiotherapy RT/hormonal treatment ADT, resection margins, nerve sparing and lymphadenectomy were included as possible predictive factors. Multivariate analysis, investigating the effect 24 months post-operation, was performed. Missing values were corrected using the full conditional specification multiple imputation (MI), with 10 imputations per missing value. Sensitivity analysis consisted of complete cases analysis.
Results: Univariate analysis proved cancer risk not significant for all outcomes excluding physical QoL (p=0.0096). On multivariate analysis, risk was not significant in predicting functional outcomes and quality of life. (all p>0.07). This together with resection margins (All p>0.19) and nerve sparing (all p>0.06). Hospital size was a positive prediction factor on global, physical, emotional and cognitive QoL, as well as sexual function (all p < 0,0074). Postoperative treatment (Urinary symptoms, ICIQ, all p < 0.0066), age (IIEF and Urinary symptoms, all p < 0.0023), early years of surgery (global QoL, ICIQ, sexual function, all p < 0.0040) and lymphadenectomy (ICIQ, p=0.0087) resulted in worse functional and quality of life outcomes. (Table 1)
Conclusions: In the largest prospective study including high risk PCa, risk category was not predictive for QoL and functional outcomes after 24 months post-RALP. Higher volume hospitals resulted in better sexual function and QoL after RALP. Postoperative RT or ADT in the first 12 months after RALP served as a negative predictor for urinary symptoms and ICIQ.
Source of Funding: De Wever foundation - Prostate cancer