Patient‐reported outcomes after open and robotic radical prostatectomy: a New Zealand registry study

Abstract

Objectives Our objective was to compare functional outcomes between open radical prostatectomy (ORP) and robotic‐assisted laparoscopic prostatectomy (RALP) in New Zealand. Methods We analysed responses from men in the Prostate Cancer Outcome Registry of New Zealand (PCOR‐NZ) who underwent ORP or RALP as primary treatment for prostate cancer between January 2016 and December 2024. We included men who completed an Expanded Prostate Cancer Index – 26 (EPIC‐26) patient‐reported outcome measure (PROM) questionnaire either at baseline, 12 months after radical prostatectomy or both. EPIC‐26 scores range from 0 to 100 (100 = best score). Established thresholds assessed minimal clinically important differences; urinary incontinence (6–9 points), urinary obstruction (5–7 points), bowel (4–6 points), sexual (10–12 points) and hormonal (4–6 points). Mean differences were calculated using multivariate analysis to adjust for age, prostate‐specific antigen and International Society of Urological Pathology grade. Additional analyses assessed daily pad usage and patient‐reported sexual function. Results Of the 4889 men who completed a questionnaire, 2844 (58.1%) underwent ORP and 2045 (41.8%) underwent RALP. PROM completion rates were 52.3% at baseline and 78.8% at 12 months after treatment. Patients who underwent RALP had higher post‐treatment PROM scores in all domains. Adjusted mean differences for urinary incontinence (6.9 points, 95% confidence interval 4.6–9.2 P < 0.001) and sexual (11.4 points, 95% confidence interval 9.1–13.7, P < 0.001) domains were above the threshold for minimal clinically important difference. Urinary obstruction, bowel and hormonal domains did not reach clinical significance. At 12 months, RALP had a higher rate of zero pads/day usage (65.1% vs 54.4% P < 0.001) and lower two or more pads/day usage (3.9% vs 10.0% P < 0.001). More men in the RALP group reported a ‘good’ to ‘very good’ sexual function at 12 months (13.7% vs 5.3%, P < 0.001). Conclusion RALP is associated with higher PROMs across all EPIC‐26 domains, with clinically meaningful benefit in sexual function, urinary incontinence and reduced incontinence pad usage at 12 months.