Function drives 1-year decision regret in radical prostatectomy: a multicentre prospective study.

OBJECTIVES

To identify contemporary drivers of postoperative decision regret 1 year after radical prostatectomy (RP).

PATIENTS AND

METHODS

In this prospective, multicentre study, patients undergoing robot-assisted RP (RARP) or retropubic open RP (ORP) for localised prostate cancer at seven centres in Germany and Austria (2022-2024) completed questionnaires preoperatively and at 1 year postoperatively. Decision regret was assessed using the Decision Regret Scale (DRS). Functional outcomes were measured with European Organisation for Research and Treatment of Cancer quality of life questionnaire - 25-item prostate cancer specific (EORTC QLQ-PR25) symptom scores at 1 year postoperatively. Multivariable logistic regression identified predictors of high surgical decision regret (DRS score ≥10). Sensitivity was tested via propensity score matching (PSM).

RESULTS

A total of 419 patients completed the surveys (58% RARP, 42% ORP) at 1 year postoperatively. Surgical decision regret was low (mean [SD] DRS score 9.0 [15.4]). Erectile dysfunction was the outcome that most patients self-reported as worse than expected (54% [221/404]), followed by urinary incontinence (23% [96/414]) and oncological cure (10% [39/397]) in a questionnaire on their retrospective perception. The ORP patients reported higher regret regarding surgical approach than RARP patients (mean [SD] DRS score 11.3 [17.1] vs 7.4 [13.9], P = 0.02). In a multivariate analysis, high urinary symptom burden (odds ratio [OR] 2.4, P = 0.009) and impaired sexual functioning (OR 2.8, P = 0.002) independently predicted high surgical decision regret whereas surgical approach and prostate-specific antigen recurrence did not. Sensitivity analyses via PSM confirmed these independent predictors.

CONCLUSIONS

Surgical decision regret after RP is primarily driven by postoperative functional outcomes rather than oncological results or surgical approach. Optimising functional recovery and managing patient expectations are key strategies to reduce regret in prostate cancer surgery.