Evaluating outcomes: Which factors should be considered following radical prostatectomy?

We hear expert insight from esteemed consultant urological and robotic surgeon Mr Benjamin Lamb on the key outcomes to consider following radical prostatectomy surgery in order to evaluate success and determine the impact on patients’ lives.

Which outcomes should be considered after a radical prostatectomy?

I have previously shared my perspectives on assessing the quality of surgical procedures and determining the suitability of a surgeon for the individual patient in my article How do I know if a surgeon is any good?. In addition, patient outcomes are a crucial aspect of evaluating quality, encompassing the effectiveness of surgery (e.g. tumour removal) and the extent of side effects experienced by patients (e.g., urinary symptoms).

Some outcomes can be objectively measured through tests or scans, while others, like sexual function, may not have straightforward measurements. Patient-reported outcome measures (PROMS), collected through validated questionnaires, offer a less biased evaluation compared to relying solely on surgeons' assessments. These measures can be obtained before and after surgery, as well as during follow-up, providing a comprehensive understanding of the patient's experience. Sometimes, complication rates are reported alongside outcomes to enhance the overall assessment of quality.

Robotic-assisted radical prostatectomy: Key outcomes to consider

When considering robotic-assisted radical prostatectomy (RARP), patient outcomes can be categorised into five key domains, known as the 'pentafecta':

1. complications
2. surgical margin status
3. urinary control
4. sexual function
5. prostate cancer control

Complications

Complications during or after RARP are generally lower compared to open or laparoscopic surgery. Higher surgeon experience and centre volume correlate with lower complication rates. The British Association of Urological Surgeons publishes complication rates for urologists performing RARP in the UK.

Surgical margin status

Surgical margin status involves ensuring the complete removal of prostate cancer. Positive surgical margins, where cancer is observed at the outer surface of the removed prostate, may indicate a higher risk of cancer recurrence. The chances of a positive surgical margin depend on the cancer stage.

Urinary control

Urinary control is a significant concern post-radical prostatectomy. While most men experience temporary issues, the majority regain control over time. Pelvic floor exercises are recommended to aid recovery, and surgical interventions are available for persistent problems.

Sexual function

Sexual function changes after RARP, affecting erectile function, orgasm, penile length, and other aspects. Nerve-sparing techniques aim to preserve sexual function, but outcomes vary based on factors such as surgical approach and patient characteristics. Medications and devices can support the recovery of erections.

Prostate cancer control

Prostate cancer control is assessed through PSA test results, additional treatment needs, scan outcomes, and mortality. Biochemical recurrence is monitored, and early intervention is crucial for effective treatment.

A comprehensive evaluation of these outcomes is vital for ensuring the quality of care in radical prostatectomy, with each domain contributing to a holistic understanding of patient experiences and long-term success. Neglecting any of these factors may compromise the overall quality of care.

If you would like to schedule a consultation with Mr Lamb, visit his Top Doctors profile today.