ENDOUROLOGY & LAPAROSCOPY

Quality of life after open or robotic prostatectomy, cryoablation or brachytherapy for localized prostate cancer
Malcolm JB, Fabrizio MD, Barone BB, Given RW, Lance RS, Lynch DF, Davis JW, Shaves ME, Schellhammer PF
Department of Urology, The Virginia Prostate Center at Eastern Virginia Medical School, Norfolk, Virginia, USA
J Urol. 2010; 183: 1822-8

• Purpose: Health related quality of life concerns factor prominently in prostate cancer management. We describe health related quality of life impact and recovery profiles of 4 commonly used operative treatments for localized prostate cancer.
  Materials and Methods: Beginning in February 2000 all patients treated with open radical prostatectomy, robot assisted laparoscopic prostatectomy, brachytherapy or cryotherapy were asked to complete the UCLA-PCI questionnaire before treatment, and at 3, 6, 12, 18, 24, 30 and 36 months after treatment. Outcomes were compared across treatment types with statistical analysis using univariate and multivariate models.
  Results: A total of 785 patients treated between February 2000 and December 2008 were included in the analysis with a mean followup of 24 months. All health related quality of life domains were adversely affected by all treatments and recovery profiles varied significantly by treatment type. Overall urinary function and bother outcomes scored significantly higher after brachytherapy and cryotherapy compared to open radical prostatectomy and robotic assisted laparoscopic radical prostatectomy. Brachytherapy and cryotherapy had a 3-fold higher rate of return to baseline urinary function compared to open radical prostatectomy and robotic assisted laparoscopic radical prostatectomy. Sexual function and bother scores were highest after brachytherapy, with a 5-fold higher rate of return to baseline function compared to cryotherapy, open radical prostatectomy and robotic assisted laparoscopic radical prostatectomy. All 4 treatments were associated with relatively transient and less pronounced impact on bowel function and bother.
  Conclusions: In a study of sequential health related quality of life assessments brachytherapy and cryotherapy were associated with higher urinary function and bother scores compared to open radical prostatectomy and da Vinci prostatectomy. Brachytherapy was associated with higher sexual function and bother scores compared to open radical prostatectomy, robotic assisted laparoscopic radical prostatectomy and cryotherapy.

• Editorial Comment
  The authors compared 4 commonly used operative treatments for localized prostate cancer: open radical prostatectomy (ORP), robot assisted laparoscopic prostatectomy (RALP), brachytherapy (BT) or cryotherapy.
  A total of 785 patients were included in the analysis with a mean follow-up of 24 months.
  BT and cryotherapy were associated with a 3-fold higher rate of return to baseline urinary function compared to ORP and RALP. Moreover, all treatments had a more adverse impact on sexual function and bother than on urinary and bowel domains.
  Although the advent of RALP has improved visualization and surgeons’ ergonomics it has not demonstrated a significant improvement of urinary continence or sexual function in this prospective, longitudinal study of health-related quality of life outcomes using validated self-reported questionnaires.
  The authors have shown the 8 years clinical follow-up analyzing different treatment modalities for localized prostate cancer. I believe this assessment should be followed by health care providers managing patients with prostate cancer so we can better serve our patients.

Dr. Fernando J. Kim
Chief of Urology, Denver Health Med. Ctr.
Associate Professor, Univ. Colorado Health Sci. Ctr.
Director of Minimally Invasive Urol. Oncology, UCHSC
Denver, Colorado, USA
E-mail: fernando.kim@dhha.org