The majority of patients undergoing RALP (robot-assisted laparoscopic prostatectomy) surgery for localized prostate cancer do not regret their treatment decision, according to findings published in December 2012 issue of The Journal of Urology.
Analysis indicates the primary factors contributing to postoperative quality of life, and therefore satisfaction or dissatisfaction with treatment choice, are pre- and postoperative sexual potency and urinary control. The study included 953 consecutive prostate cancer treatment patients with RALP performed by Dr. David Samadi, Vice Chairman of the Department of Urology and Chief of Robotics and Minimally Invasive Surgery at New York’s Mount Sinai Medical Center.
At a median of 11.1 months after robotic surgery, 74 percent completed questionnaires regarding quality of life and treatment decisional regret. Of these patients, 88 percent reported satisfaction with their decision to have RALP. Dr. Samadi performs custom RALP surgery using the Samadi Modified Assisted Robotic Technique (SMART).
In this study Dr. Samadi and his colleagues sought to define specific factors impacting patient decisional regret following RALP for localized prostate cancer. Their analysis focused on the relationship between independent baseline status and quality of life after surgery, namely patient age and erectile and urinary functions before and after surgery. “It is encouraging that nearly a year after surgery, the majority of my patients are satisfied with their treatment choice and quality of life,” said Dr. Samadi. “I believe these findings highlight the importance of pre-op counseling; working one-on-one with patients and their partners to provide a realistic assessment of before and after functions.”
Patient-reported data indicated that those with preexisting erectile dysfunction (ED) have greater difficulty with sexual potency after surgery. In terms of regret, however, men with superior preoperative erectile functions were more bothered by postoperative sexual issues that those already experiencing some degree of ED.
Additionally, patients with severe baseline lower urinary tract symptoms (LUTS) were more regretful after surgery, despite their preexisting urinary problems. “What we found,” explained Dr. Samadi, “is that patient satisfaction with robotic prostate surgery depends on a range of pre- and postoperative variables. This reinforces the need for patient-specific treatment counseling before surgery and a continuing doctor-patient relationship during post-surgery rehabilitation.” Though not included in this study, ongoing patient data indicates that 96 percent of Dr. Samadi’s patients regain urinary continence within two to three months of surgery and sexual potency within 12-24 months. To date, Dr. Samadi has performed more than 4,000 successful SMART prostatectomy surgeries.