MP74-14: Health-related quality of life after open and robot-assisted radical prostatectomy: A propensity score matched analysis.

Alexander Kretschmer, Robert Bischoff, Alexander Buchner, Michael Chaloupka, Philipp Weinhold, Thilo Westhofen, Friedrich Jokisch, Frank Strittmatter, Armin Becker, Christian G. Stief

Introduction: Introduction of robot-assisted radical prostatectomy (RARP) has revolutionized the therapeutic landscape of organ confined prostate cancer (PCa) over the last two decades. However, comparative analyses focused on health-related quality of life (HRQOL) after RARP and open retropubic prostatectomy (ORP) are rare. In the current. Study, we analyse differences in preoperative and postoperative HRQOL after ORP and RARP in a propensity score matched patient cohort with favourable preoperative patient characteristics.

Methods: In the current retrospective analysis, inclusion criteria encompassed PSA =10ng/ml, =pT2c, ISUP =3, age =65yrs, as well as preoperative continence. A propensity score matched patient cohort [n=418 (ORP: 209, RARP: 209)] was created and HRQOL was assessed based on validated questionnaires preoperatively, 3mo, 12mo, or 24mo postoperatively. Primary endpoint was good general HRQOL based on previously published cut-off values. Secondary endpoints encompassed the respective HRQOL subdomains as well as functional outcomes at different timepoints. Erectile function was measured via IIEF-5, urinary continence via ICIQ-SF questionnaire. Multivariable analysis included binary logistic regression models (p<0.05).

Results: ORP and RARP cohorts were well-balanced. After 3mo, continence results based on mean ICIQ-SF scores were superior for ORP compared to RARP (3.9 vs. 5.3; p=0.003) with no differences at the remaining time points. After 24mo, 64.3 (ORP) vs 73.8% (RARP) of the preoperatively potent patients had regained IIEF-5 scores of 18 or more (p=0.190). Mean QLQ-C30 global health status was significantly higher for ORP compared to RARP after 3mo (70.1 vs. 61.6, p=0.001), but not after the remaining follow-up periods. There were no significant differences regarding the remaining QLQ-C30 functioning and symptom scores in the longer-term follow-up. In multivariable analysis stratified for IIEF-5 and ICIQ-SF scores and surgeon experience, RARP could be confirmed as an marginally independent predictor for lower ratios of good general HRQOL after 3mo (OR 0.464, 95% CI 0.215 – 0.999; p=0.050) without any differences at the remaining time points.

Conclusions: The current study addresses various HRQOL outcomes over an postoperative period of up to 2 years in a homogenous propensity score matched contemporary cohort. Marginally better general HRQOL outcomes could be detected for ORP compared to RARP 3mo postoperatively. Functional outcomes were comparable between both surgical techniques. Source of

Funding: none