Quality of life after robotic-assisted and laparoscopic radical prostatectomy: Results of a multicenter randomized controlled trial (LAP-01).

BACKGROUND: To explore cross-sectional and longitudinal differences in general health-related and prostate cancer-specific quality of life (QoL) after robotic-assisted (RARP) and laparoscopic (LRP) radical prostatectomy and to analyze predictive variables for QoL outcomes. METHODS: In this multicenter, randomized controlled trial, prostate cancer patients were randomly assigned 3:1 to undergo either RARP or LRP. Patient-reported outcomes were prospectively collected before and 1, 3, 6, 12 months after radical prostatectomy and included QoL as a secondary outcome. Validated questionnaires were used to assess general health-related (EORTC QLQ-C30) and prostate cancer-specific (QLQ-PR25) QoL. Cross-sectional and longitudinal contrasts were analyzed through linear mixed models. Predictive variables for QoL outcomes were identified by general linear modeling. RESULTS: Of 782 randomized patients, QoL was evaluable in 681 patients. In terms of general QoL, the cross-sectional analysis showed only small differences between study arms, whereas longitudinal comparison indicated an advantage of RARP on recovery: RARP patients reported an earlier return to baseline in global health status (3 vs. 6 months) and social functioning (6 vs. 12 months). In role functioning, only the RARP arm regained baseline scores. Regarding prostate-specific QoL, LRP patients experienced more urinary symptoms and reported 3.2 points (95% confidence interval 0.4-6, p = 0.024) higher mean scores at 1-month follow-up and in mean 2.9 points (0.1-5, p = 0.042) higher urinary symptoms scores at 3-month follow-up than RARP patients. There were no other significant differences between treatment groups. Urinary symptoms, sexual activity, and sexual function remained significantly worse compared with baseline at all time points in both arms. CONCLUSIONS: Compared with LRP, the robotic approach led to an earlier return to baseline in several domains of general health-related QoL and better short-term recovery of urinary symptoms. Predictive variables such as the scale-specific baseline status and bilateral nerve-sparing were confirmed.

Impact of the use of an endorectal coil for 3 T prostate MRI on image quality and cancer detection rate.

This work aims to assess the impact of an additional endorectal coil on image quality and cancer detection rate within the same patients. At a single academic medical center, this transversal study included 41 men who underwent T2- and diffusion-weighted imaging at 3 T using surface coils only or in combination with an endorectal coil in the same session. Two blinded readers (A and B) randomly evaluated all image data in separate sessions. Image quality with respect to localization and staging was rated on a five-point scale. Lesions were classified according to their prostate imaging reporting and data system (PIRADS) score version 1. Standard of reference was provided by whole-mount step-section analysis. Mean image quality scores averaged over all localization-related items were significantly higher with additional endorectal coil for both readers (p < 0.001), corresponding staging-related items were only higher for reader B (p < 0.001). With an endorectal coil, the rate of correctly detecting cancer per patient was significantly higher for reader B (p < 0.001) but not for reader A (p = 0.219). The numbers of histologically confirmed tumor lesions were rather similar for both settings. The subjectively rated 3-T image quality was improved with an endorectal coil. In terms of diagnostic performance, the use of an additional endorectal coil was not superior.