Baseline Functional Status May Predict Decisional Regret Following Robotic Prostatectomy

No AccessJournal of UrologyAdult Urology1 Dec 2012Baseline Functional Status May Predict Decisional Regret Following Robotic Prostatectomy Hugh J. Lavery, Adam W. Levinson, Adele R. Hobbs, Dov Sebrow, Nihal E. Mohamed, Michael A. Diefenbach, and David B. Samadi Hugh J. LaveryHugh J. Lavery , Adam W. LevinsonAdam W. Levinson , Adele R. HobbsAdele R. Hobbs , Dov SebrowDov Sebrow , Nihal E. MohamedNihal E. Mohamed , Michael A. DiefenbachMichael A. Diefenbach , and David B. SamadiDavid B. Samadi View All Author Informationhttps://doi.org/10.1016/j.juro.2012.08.016AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Physician knowledge of factors related to patient decisional regret following definitive management for localized prostate cancer is an important but under evaluated element in comprehensive patient counseling. Using validated instruments, we analyzed the relationships of pathological, perioperative and functional health related quality of life variables to treatment related regret following robot-assisted laparoscopic prostatectomy. Materials and Methods: Of 953 consecutive patients presenting for followup after robot-assisted laparoscopic prostatectomy 703 (74%) completed validated measures of health related quality of life and treatment decisional regret. Baseline functional measures were assessed with the Sexual Health Inventory for Men and International Prostate Symptom Score. Questionnaires were administered a median of 11.1 months (IQR 4.6–26.1) after surgery. Clinicopathological, perioperative and functional outcomes were analyzed with univariable and multivariable models to examine associations with patient decisional regret. Results: Of the patients 88% did not regret the decision to undergo robot-assisted laparoscopic prostatectomy. Baseline health related quality of life, specifically baseline incontinence and superior erectile function, independently predicted increased postoperative decisional regret. In addition, older age, postoperative incontinence measured by pad use, postoperative erectile dysfunction and longer time from surgery were independent predictors of increased decisional regret. Preoperative cancer risk, and histopathological and short-term biochemical outcomes were unrelated to decisional regret. Conclusions: Decisional regret following robot-assisted laparoscopic prostatectomy is independently predicted by age, baseline urinary and erectile function, perioperative outcomes, and postoperative urinary and erectile function. These results may be useful to urologists during preoperative patient counseling to set realistic expectations for the postoperative course, potentially improving the surgical experience. References 1 : Regret of treatment decision and its association with disease-specific quality of life following prostate cancer treatment. Cancer Invest2007; 25: 449. Google Scholar 2 : Satisfaction and regret after open retropubic or robot-assisted laparoscopic radical prostatectomy. Eur Urol2008; 54: 785. Google Scholar 3 : Living with treatment decisions: regrets and quality of life among men treated for metastatic prostate cancer. J Clin Oncol2001; 19: 72. Google Scholar 4 : Fear of recurrence, treatment satisfaction, and quality of life after radical prostatectomy for prostate cancer. Support Care Cancer2008; 16: 161. Google Scholar 5 : Regret in men treated for localized prostate cancer. J Urol2003; 169: 2279. Link, Google Scholar 6 : Pretreatment expectations of patients undergoing robotic assisted laparoscopic or open retropubic radical prostatectomy. J Urol2012; 187: 894. Link, Google Scholar 7 : Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med2008; 358: 1250. Google Scholar 8 : Racial/ethnic differences in functional outcomes in the 5 years after diagnosis of localized prostate cancer. J Clin Oncol2004; 22: 4193. Google Scholar 9 : Determinants of long-term sexual health outcome after radical prostatectomy measured by a validated instrument. J Urol2003; 169: 1453. Link, Google Scholar 10 : Validation of a decision regret scale. Med Decis Making2003; 23: 281. Google Scholar 11 : The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology1997; 49: 822. Google Scholar 12 : The American Urological Association symptom index for benign prostatic hyperplasia: The Measurement Committee of the American Urological Association. J Urol1992; 148: 1549. Abstract, Google Scholar 13 : The International Index of Erectile Function (IIEF): a state-of-the-science review. Int J Impot Res2002; 14: 226. Google Scholar 14 : The correlation between erectile function and patient satisfaction. J Sex Med2007; 4: 472. Google Scholar 15 : Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer. J Urol2003; 169: 517. Link, Google Scholar 16 : Continence definition after radical prostatectomy using urinary quality of life: evaluation of patient reported validated questionnaires. J Urol2010; 183: 1464. Link, Google Scholar 17 : Variation in continence and potency by definition. J Urol2003; 170: 1291. Link, Google Scholar 18 : Prospective assessment of patient reported urinary continence after radical prostatectomy. J Urol2000; 164: 744. Link, Google Scholar 19 : Pad use and patient reported bother from urinary leakage after radical prostatectomy. J Urol2012; 187: 196. Link, Google Scholar 20 : Health related quality of life significance of single pad urinary incontinence following radical prostatectomy. J Urol2003; 170: 512. Link, Google Scholar 21 : Partnerships with patients: the pros and cons of shared clinical decision-making. J Health Serv Res Policy1997; 2: 112. Google Scholar 22 : Robotic-assisted prostatectomy: is there truth in advertising?. Eur Urol2008; 54: 720. Google Scholar 23 : Health outcomes after prostatectomy or radiotherapy for prostate cancer: results from the Prostate Cancer Outcomes Study. J Natl Cancer Inst2000; 92: 1582. Google Scholar 24 : A cohort study investigating patient expectations and satisfaction outcomes in men undergoing robotic assisted radical prostatectomy. Int Urol Nephrol2010; 43: 405. Google Scholar 25 : Incontinence after radical prostatectomy: a patient centered analysis and implications for preoperative counseling. J Urol2011; 186: 204. Link, Google Scholar 26 : Decisional regret and quality of life after participating in medical decision-making for early-stage prostate cancer. BJU Int2003; 91: 14. Google Scholar 27 : Continence following radical retropubic prostatectomy using self-reporting instruments. J Urol2004; 171: 1212. Link, Google Scholar 28 : Prediction of erectile function following treatment for prostate cancer. JAMA2011; 306: 1205. Google Scholar 29 : Can sexual bother after radical prostatectomy be predicted preoperatively?: Findings from a prospective national study of the relation between sexual function, activity and bother. BJU Int2012; 109: 1366. Google Scholar 30 : Prostate cancer-specific mortality after radical prostatectomy for patients treated in the prostate-specific antigen era. J Clin Oncol2009; 27: 4300. Google Scholar Department of Urology, Mount Sinai Medical Center, New York, New York© 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byBaunacke M, Schmidt M, Groeben C, Borkowetz A, Thomas C, Koch R, Chun F, Ihrig A, Weissbach L and Huber J (2019) Decision Regret after Radical Prostatectomy does Not Depend on Surgical Approach: 6-Year Followup of a Large German Cohort Undergoing Routine CareJournal of Urology, VOL. 203, NO. 3, (554-561), Online publication date: 1-Mar-2020.Meenakshi-Sundaram B, Coco C, Furr J, Dubow B, Aston C, Lewis J, Slobodov G, Kropp B and Frimberger D (2018) Analysis of Factors Associated with Patient or Caregiver Regret following Surgery for Fecal IncontinenceJournal of Urology, VOL. 199, NO. 1, (274-279), Online publication date: 1-Jan-2018.Taneja S (2018) Re: Treatment Decision Regret among Long-Term Survivors of Localized Prostate Cancer: Results from the Prostate Cancer Outcomes StudyJournal of Urology, VOL. 198, NO. 5, (980-983), Online publication date: 1-Nov-2017.Lorenzo A, Pippi Salle J, Zlateska B, Koyle M, Bägli D and Braga L (2014) Decisional Regret after Distal Hypospadias Repair: Single Institution Prospective Analysis of Factors Associated with Subsequent Parental Remorse or DistressJournal of Urology, VOL. 191, NO. 5S, (1558-1563), Online publication date: 1-May-2014. Volume 188Issue 6December 2012Page: 2213-2218Supplementary Materials Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Keywordsprostatectomyroboticsemotionsprostateprostatic neoplasmsMetricsAuthor Information Hugh J. Lavery More articles by this author Adam W. Levinson More articles by this author Adele R. Hobbs More articles by this author Dov Sebrow More articles by this author Nihal E. Mohamed More articles by this author Michael A. Diefenbach More articles by this author David B. Samadi More articles by this author Expand All Advertisement PDF downloadLoading ...