Patient Centered Outcomes in Prostate Cancer Treatment: Predictors of Satisfaction Up to 2 Years After Open Radical Retropubic Prostatectomy

Abraham, N.E., D.V. Makarov, J. Laze, E. Stefanovics, R. Desai, and H. Lepor, Herbert
Journal of Urology, Vol. 184, no. 5, pp. 1977-1981. DOI: 10.1016/j.juro.2010.06.099

Purpose: Few groups have examined satisfaction after prostate cancer treatment. We determined 1) predictors of satisfaction between 3 months and 2 years after open radical retropubic prostatectomy, and 2) whether these factors are time dependent.

Materials and Methods: This prospective cohort study included 1,542 men who underwent radical retropubic prostatectomy from October 2000 to July 2008. The primary outcome was satisfaction self-assessed at 3, 6, 12 and 24 months. We used multivariate logistic regression and repeated measures analysis to determine predictors of satisfaction, adjusting for demographic and clinical characteristics.

Results: Median followup was 24 months. About 93% of the men were satisfied. On multivariate analysis men were significantly less satisfied at 3 months when the urinary catheter was indwelling for 3 weeks or greater (OR 0.23, 95% CI 0.10–0.54), or they required intervention for anastomotic stricture (OR 0.23, 95% CI 0.11–0.49) or experienced 4-point or greater worsening in American Urological Association symptom score (OR 0.26, 95% CI 0.13–0.49). At 6 months worsening urinary function (OR 0.34, 95% CI 0.13–0.88) and biochemical failure (OR 0.15, 95% CI 0.05–0.43) were significantly associated with satisfaction. Worsening sexual function became significant at 12 and 24 months. These associations were confirmed on repeated measures analysis.

Conclusions: Most men were satisfied after radical retropubic prostatectomy. Satisfaction determinants showed a nonsignificant trend toward time dependence. Postoperative factors, such as the duration of indwelling Foley catheterization, were associated with short-term satisfaction while sexual and urinary function, and biochemical failure were associated with long-term satisfaction. Based on high satisfaction rates open radical retropubic prostatectomy is an excellent treatment for prostate cancer.

Wagner Faculty