title: Decisional regret after robotic-assisted laparoscopic prostatectomy is higher in African American men.
abstract: OBJECTIVE
  Longitudinal studies report racial disparities in prostate cancer (PCa) including greater incidence, more aggressive tumor biology, and increased cancer-specific mortality in African American (AA) men. Regret concerning primary treatment selection is underevaluated in patients with PCa. We investigated the relationships between clinicopathologic variables across racial and socioeconomic lines following robotic-assisted laparoscopic prostatectomy.
  
  
  METHODS
  We assessed treatment decisional regret using a validated questionnaire in a total of 484 white and 72 AA patients with PCa who were followed up for a median of 16.6 months post-robotic-assisted laparoscopic prostatectomy. Socioeconomic status (SES) information was aggregated from 2010 US census zip code data. Perioperative clinicopathologic characteristics and functional outcomes were compared between groups. Univariate and multivariate regression analyses were used to evaluate the influence of race, aggregate SES, and other clinical and demographic characteristics on decisional regret.
  
  
  RESULTS
  The majority (87.7%) of the population was not regretful of their decision to undergo treatment. However, a greater proportion of AA vs. white patients were regretful (20.6% vs. 11.2%, respectively; P = 0.03). AA and white men were similar on all functional, clinical, and pathologic features with the exception of younger age among AA men (56 vs. 60 y, respectively; P<0.001). Although there were significant differences in SES by race (P<0.001), regret did not differ by SES (β =-1.53; P = 0.15). Race, postoperative sexual dysfunction, pad usage, and length of hospital stay, however, were significantly associated with decisional regret.
  
  
  CONCLUSIONS
  AA men were more regretful than white men, after adjusting for clinicopathologic characteristics and postoperative functional outcomes.
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, New York, NY.
authors.forename: Shemille A
authors.initials: SA
authors.lastname: Collingwood
authors.affiliation: Department of Pathology, The Mount Sinai Medical Center, New York, NY; The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Russell B
authors.initials: RB
authors.lastname: McBride
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, New York, NY.
authors.forename: Michael
authors.initials: M
authors.lastname: Leapman
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, New York, NY.
authors.forename: Adele R
authors.initials: AR
authors.lastname: Hobbs
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, New York, NY; Department of Urology, Mercer University School of Medicine, New York, NY.
authors.forename: Young Suk
authors.initials: YS
authors.lastname: Kwon
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, New York, NY.
authors.forename: Kristian D
authors.initials: KD
authors.lastname: Stensland
authors.affiliation: Department of Population Health, Hofstra North Shore LIJ School of Medicine, Great Neck, NY.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Schwartz
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, New York, NY.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Pollard
authors.affiliation: Department of Urology, North Shore LIJ-Lenox Hill Hospital, New York, NY. Electronic address: samadiroboticinstitute@gmail.com.
authors.forename: David B
authors.initials: DB
authors.lastname: Samadi
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D003657:Decision Making; D004644:Emotions; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D011468:Prostatectomy / Q000523:psychology*; D011471:Prostatic Neoplasms / Q000523:psychology* / Q000601:surgery; D011788:Quality of Life; D012371:Robotics; D011795:Surveys and Questionnaires; D044465:White People / Q000523:psychology
keywords: Prostate; Prostatectomy; Quality of life; Race; Socioeconomic status