Health related quality of life before and after laparoscopic radical prostatectomy.
OBJECTIVE
The viability of laparoscopic radical prostatectomy (LRP) as a surgical treatment for prostate cancer depends on oncological and health related quality of life (HRQOL) outcomes. We present a prospective assessment of HRQOL in 122 patients before and after LRP using the validated Expanded Prostate Cancer Index Composite (EPIC) questionnaire.


METHODS
EPIC data were collected preoperatively, and at 3, 6 and 12 months after LRP, and all were normalized to patient preoperative baseline responses.


RESULTS
Using traditional single question responses, 93.4% of patients were continent (0 to 1 pads) at postoperative month 12. Of previously potent men who underwent bilateral nerve sparing 78.9% reported engaging in sexual intercourse within postoperative year 1. However, EPIC domain scores provided a more comprehensive assessment of functional outcomes. For the urinary incontinence subdomain, the majority of functional recovery was achieved by postoperative month 6, reaching a 74% return to baseline on average. In contrast, recovery of the sexual function subdomain continued throughout postoperative year 1 (to a mean of 64%). Recovery of sexual function was not significantly affected by age or preoperative potency status, although the extent of nerve sparing was a significant predictor of outcome (mean recovery to 75% of baseline for bilateral vs 36% for no nerve sparing at 12 months, p = 0.005).


CONCLUSIONS
Nerve sparing LRP provides satisfactory first year HRQOL outcomes when assessed with a validated instrument. The time course and extent of functional recovery documented in this prospective study may prove useful for patient counseling before LRP.
Link
Richard E
RE
James Buchanan Brady Urological Institute, Johns Hopkins Bayview Medical Center, 600 North Wolfe Street, Jefferson Street Building, Baltimore, Maryland 21287, USA. rlink5@jhmi.edu
Su
Li-Ming
LM
Sullivan
Wendy
W
Bhayani
Sam B
SB
Pavlovich
Christian P
CP
D006801:Humans; D010535:Laparoscopy; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000453:epidemiology