Decision Regret after Radical Prostatectomy does Not Depend on Surgical Approach: 6-Year Followup of a Large German Cohort Undergoing Routine Care

No AccessJournal of UrologyAdult Urology1 Mar 2020Decision Regret after Radical Prostatectomy does Not Depend on Surgical Approach: 6-Year Followup of a Large German Cohort Undergoing Routine CareThis article is commented on by the following:Editorial CommentEditorial Comment Martin Baunacke, Maria-Luisa Schmidt, Christer Groeben, Angelika Borkowetz, Christian Thomas, Rainer Koch, Felix K. H. Chun, Andreas Ihrig, Lothar Weissbach, and Johannes Huber Martin BaunackeMartin Baunacke Department of Urology, Technische Universität Dresden, Dresden, Germany , Maria-Luisa SchmidtMaria-Luisa Schmidt Department of Urology, Technische Universität Dresden, Dresden, Germany , Christer GroebenChrister Groeben Department of Urology, Technische Universität Dresden, Dresden, Germany , Angelika BorkowetzAngelika Borkowetz Department of Urology, Technische Universität Dresden, Dresden, Germany , Christian ThomasChristian Thomas Department of Urology, Technische Universität Dresden, Dresden, Germany , Rainer KochRainer Koch Department of Urology, Technische Universität Dresden, Dresden, Germany , Felix K. H. ChunFelix K. H. Chun Department of Urology, Goethe-University Hospital, Frankfurt-Main, Germany , Andreas IhrigAndreas Ihrig Division of Psycho-Oncology, Department of Psychosomatic and General Internal Medicine, University of Heidelberg, Heidelberg, Germany , Lothar WeissbachLothar Weissbach Health Research for Men GmbH, gfm, Berlin, Germany , and Johannes HuberJohannes Huber *Correspondence: Department of Urology, Technische Universität Dresden, Fetscherstr. 74, 01307Dresden, Germany telephone: +49 351 458-18954; E-mail Address: [email protected] Department of Urology, Technische Universität Dresden, Dresden, Germany View All Author Informationhttps://doi.org/10.1097/JU.0000000000000541AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Numerous studies have compared the outcomes of open and robot-assisted radical prostatectomy but to our knowledge only 1 study has focused on patient satisfaction and regret. We evaluated intermediate term decision regret after open and robot-assisted radical prostatectomy. Materials and Methods: The HAROW (Hormonal Therapy, Active Surveillance, Radiation, Operation, Watchful Waiting) study analyzed localized prostate cancer treatments (T2c N0 M0 or less) in Germany from 2008 to 2013. We collected intermediate term followup data on 1,260 patients after retropubic open or robot-assisted radical prostatectomy. Results: The response rate was 76.8% (936 of 1,218 cases). A total of 404 patients underwent robot-assisted radical prostatectomy and 532 underwent open radical prostatectomy. Patients treated with the robot-assisted procedure showed more self-determined behavior. They reported an active role in surgical decision making and the surgical approach (robot-assisted radical vs open prostatectomy 39% vs 24% and 52% vs 18%, respectively, each p <0.001). Patients treated with the robot-assisted procedure more often participated actively in selecting the treating hospital (25% vs 11%), used the Internet often (87% vs 72%) and traveled an increased distance (63 vs 42 km, all p <0.001). Overall decision regret was low with a mean ± SD score of 14 ± 19 on a scale of 0—no regret to 100—high regret. Multivariate analysis showed that erectile function (OR 3.2), urinary continence (OR 1.8), freedom from recurrence (OR 1.6), an active decision making role (OR 2.2) and shorter followup (OR 0.9 per year) predicted low decision regret (score less than 15). Conclusions: Intermediate term functional and oncologic outcomes as well as autonomous decision making and followup time influenced decision regret after radical prostatectomy. The surgical approach was not associated with intermediate term decision regret. References 1. : Regret in cancer-related decisions. Health Psychol 2005; 24: S29. 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Google Scholar 30. : Health economic analysis of open and robot-assisted laparoscopic surgery for prostate cancer within the prospective multicentre LAPPRO trial. Eur Urol 2018; 74: 816. Google Scholar The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Supported by a research grant from Intuitive Surgical, Inc., 2017 to 2019, and Gazprom Germania (HAROW). The Intuitive Surgical grant had no influence on study performance. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologyDec 3, 2019, 12:00:00 AMEditorial CommentJournal of UrologyDec 3, 2019, 12:00:00 AMEditorial Comment Volume 203Issue 3March 2020Page: 554-561Supplementary Materials Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsclinical decision-makingprostatic neoplasmsprostatectomyemotionsGermanyAcknowledgmentElke Hempel, Managing Director, SMG Forschungsgesellschaft mbH, provided study support.MetricsAuthor Information Martin Baunacke Department of Urology, Technische Universität Dresden, Dresden, Germany More articles by this author Maria-Luisa Schmidt Department of Urology, Technische Universität Dresden, Dresden, Germany More articles by this author Christer Groeben Department of Urology, Technische Universität Dresden, Dresden, Germany More articles by this author Angelika Borkowetz Department of Urology, Technische Universität Dresden, Dresden, Germany More articles by this author Christian Thomas Department of Urology, Technische Universität Dresden, Dresden, Germany More articles by this author Rainer Koch Department of Urology, Technische Universität Dresden, Dresden, Germany More articles by this author Felix K. H. Chun Department of Urology, Goethe-University Hospital, Frankfurt-Main, Germany More articles by this author Andreas Ihrig Division of Psycho-Oncology, Department of Psychosomatic and General Internal Medicine, University of Heidelberg, Heidelberg, Germany More articles by this author Lothar Weissbach Health Research for Men GmbH, gfm, Berlin, Germany More articles by this author Johannes Huber Department of Urology, Technische Universität Dresden, Dresden, Germany *Correspondence: Department of Urology, Technische Universität Dresden, Fetscherstr. 74, 01307Dresden, Germany telephone: +49 351 458-18954; E-mail Address: [email protected] More articles by this author Expand All The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Supported by a research grant from Intuitive Surgical, Inc., 2017 to 2019, and Gazprom Germania (HAROW). The Intuitive Surgical grant had no influence on study performance. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Advertisement Loading ...