Clinical use of expanded prostate cancer index composite-based health-related quality of life outcomes after robot-assisted radical prostatectomy for localized prostate cancer

Abstract

Background: This study aimed to assess the longitudinal health-related quality of life (HRQOL) using the Expanded Prostate Cancer Index Composite (EPIC) and HRQOL change between the nerve-sparing technique in Japanese men treated with robot-assisted radical prostatectomy (RARP).

Methods: A total of 573 patients who received RARP were included in this study. EPIC questionnaire was administered before treatment and up to 36 months after RARP. Clinical recovery was defined as half of the standard deviation of the baseline score for each domain. We divided all patients into recovery group or nonrecovery group. The time from survey to each domain recovery was calculated using the Kaplan-Meier method. We compared the sexual and urinary score change between groups using analysis of variance to confirm the effect of nerve-sparing technique.

Results: The median age was 67 years (interquartile range, 62-71 years). The mean score of all urinary domains worsened noticeably after 1 month. All postoperative urinary summary, function, and incontinence scores were significantly lower than preoperative scores up to 3 years post-RARP. Postoperative sexual summary and functional scores were significantly lower than preoperative score at all follow-up times throughout the 36 months. The recovery rate for the urinary incontinence domain was the lowest (44.5%), whereas the recovery rate for the urinary irritative-obstructive domain was the highest (73.7%). In the sexual domain, the bother domain had a higher recovery rate (73.0%) than the functional domain (29.7%). Although the recovery of sexual domains was slower compared with other domains, by 36 months after RARP, almost all values had recovered. Compared with other technique groups, bilateral intrafascial nerve-sparing group showed significantly decreased change in subscale scores before and after RARP in several sexual and urinary domain.

Conclusion: The time course and extent of functional and bother domain recovery documented in this study may prove useful for RARP patient selection in Japan.

Keywords: Nerve-sparing surgery; Prostate cancer; Quality of life; Robot-assisted radical prostatectomy.

Fig. 1

Longitudinal changes in urinary, bowel, sexual, hormonal, and satisfactory domain mean scores over time. Bars represent mean ± SE. (A) Urinary summary scores (US). (B) Urinary function scores (UF). (C) Urinary bother scores (UB). (D) Urinary irritative–obstructive scores (UIR). (E) Urinary incontinence scores (UI). (F) Bowel summary scores (BS). (G) Bowel function scores (BF). (H) Bowel bother scores (BB). (I) Sexual summary scores (SS). (J) Sexual function scores (SF). (K) Sexual bother scores (SB). (L) Hormonal summary scores (HS). (M) Hormonal function scores (HF). (N) Hormonal bother scores (HB). (O) Satisfactory scores (SAT).

Fig. 2

Kaplan–Meier analysis of the proportion of subjects returning to recovery urinary, bowel, sexual, hormonal, and satisfactory score^a) over time. (A) Urinary summary scores (US). (B) Urinary function scores (UF). (C) Urinary bother scores (UB). (D) Urinary irritative–obstructive scores (UIR). (E) Urinary incontinence scores (UI). (F) Bowel summary scores (BS). (G) Bowel function scores (BF). (H) Bowel bother scores (BB). (I) Sexual summary scores (SS). (J) Sexual function scores (SF). (K) Sexual bother scores (SB). (L) Hormonal summary scores (HS). (M) Hormonal function scores (HF). (N) Hormonal bother scores (HB). (O) Satisfactory scores (SAT). ^a)Recovery group defined as change score that was greater than (preoperative value − ½ SD preoperative value) for respective subscales.

Fig. 3

The Δ score (prescore – nadir score after RARP) for each nerve-sparing technique groups in sexual and urinary scores. Group 0, non-nerve-sparing; group 1, unilateral ITR-NS; group 2, unilateral ITE-NS; group 3, bilateral ITR-NS; 4, bilateral ITE-NS. (A) Sexual summary scores (SS; mean ± SD). Group 0, 21.9 ± 17.5; group 1, 26.8 ± 19.9; group 2, 19.7 ± 16.2; group 3, 15.8 ± 19.4; group 4, 20.9 ± 19.9. ANOVA demonstrated significant differences between groups (P = 0.006). (B) Sexual function scores (SF; mean ± SD). Group 0, 23.5 ± 19.0; group 1, 26.9 ± 21.4; group 2, 23.4 ± 19.4; group 3, 20.4 ± 18.4; group 4, 22.2 ± 20.7. There were no significant differences between groups (P = 0.345). (C) Sexual bother scores (SB; mean ± SD). Group 0, 22.4 ± 29.9; group 1, 29.7 ± 31.4; group 2, 16.8 ± 31.2; group 3, 4.1 ± 31.4; group 4, 21.7 ± 33.2. ANOVA demonstrated significant differences between groups (P < 0.001). (D) Urinary summary scores (US; mean ± SD). Group 0, 27.4 ± 18.6; group 1, 29.9 ± 18.9; group 2, 29.1 ± 19.7; group 3, 13.9 ± 13.3; group 4, 23.0 ± 18.9. There are significant differences between groups (P < 0.001). (E) Urinary function scores (UF; mean ± SD). Group 0, 37.8 ± 23.4; group 1, 39.0 ± 23.2; group 2, 37.9 ± 24.5; group 3, 19.9 ± 16.4; group 4, 37.0 ± 22.6. There are significant differences between groups (P < 0.001). (F) Urinary bother scores (UB; mean ± SD). Group 0, 21.4 ± 18.4; group 1, 22.5 ± 19.3; group 2, 22.8 ± 19.5; group 3, 8.7 ± 14.3, group 4, 14.2 ± 17.9. There are significant differences between groups (P < 0.001). (G) Urinary irritative–obstructive scores (UIR; mean ± SD). Group 0, 14.2 ± 16.4; group 1, 15.8 ± 18.7; group 2, 14.8 ± 18.4; group 3, 3.25 ± 9.8; group 4, 9.8 ± 17.3. There are significant differences between groups (P < 0.001). (H) Urinary incontinence scores (UI; mean ± SD). Group 0, 52.8 ± 32.2; group 1, 55.2 ± 30.9; group 2, 52.1 ± 31.8; group 3, 30.7 ± 24.2; group 4, 47.7 ± 30.6. There are significant differences between groups (P < 0.001).