Type of surgical approach to radical prostatectomy—robot-assisted vs open procedure—is not associated with a patient’s intermediate-term decision regret, according to a recent study.
Johannes Huber, MD, PhD, of Technische Universität Dresden in Germany, and colleagues conducted a follow-up of the HAROW (Hormonal Therapy, Active Surveillance, Radiation, Operation, Watchful Waiting) study involving 936 (of 1218) men who underwent surgery for localized prostate cancer in Germany during 2008 to 2013. A total of 404 patients had robot-assisted radical prostatectomy (RARP) and 532 underwent open radical prostatectomy (ORP) at 114 hospitals, representing a quarter of all hospitals in the country.
Overall, distress or remorse over their decision was low at a median 6.3 years, with a mean score of 14 on a range of 0 (no regret) to 100 (high regret). The investigators found no significant difference in decision regret between the 2 surgical approaches (mean RARP 12 vs ORP 15).
Nearly a third of patients preferred an active role, and 57% preferred shared decision-making for prostate cancer therapy. RARP patients appeared more self-determined than ORP patients.
A significantly higher proportion of patients undergoing robot-assisted vs open surgery actively participated in the decision to undergo surgery (39% vs 24%) and the choice of surgical approach (52% vs 18%), Dr Huber’s team reported the Journal of Urology. More RARP patients also used the internet often as a source of health care information (87% vs 72%), selected the treating hospital (especially a high-volume hospital) based on an information search (25% vs 11%), and traveled a long distance (63 vs 42 km).
In line with previous research, patients with good functional and oncological outcomes had low regret regardless of the surgical approach. In multivariate analyses, erectile function, urinary continence, freedom from recurrence, an active decision-making role, and shorter follow-up time, in descending order, predicted low decision regret (score less than 15).
“For future research it will be a worthwhile question whether an active role in treatment decision making is an individual trait or whether it can be influenced by decision aids or counseling.”
Baunacke M, Schmidt M-L, Groeben C, et al. Decision regret after radical prostatectomy does not depend on surgical approach: 6-year followup of a large German cohort undergoing routine care [published online September 13, 2019]. J Urol. doi: 10.1097/JU.0000000000000541
Most men do not regret their choices for prostate cancer surgery [news release]. Wolters Kluwer Health; February 10, 2020.