Radical prostatectomy and radiotherapy are standard treatments for localized prostate cancer. When making decisions about treatment, it is important to not only consider medical information and complications, but also the impact on quality of life (QOL) after treatment. Our purpose was to compare QOL after robot-assisted laparoscopic radical prostatectomy (RARP) versus radiation therapy with high risk localized prostate cancer retrospectively.

Patients with high risk localized prostate cancer receiving RARP (Group A), intensity-modulated radiation therapy (IMRT) (Group B) and brachytherapy combined with external beam radiation therapy (EBRT) (Group C) at our department between October 2010 and March 2017 were enrolled in this study. QOL was assessed using the Expanded Prostate Cancer Index Composite (EPIC) before treatment and 1, 3, 6, 12, 18, 24, and 36 months post-treatment in each group. Urinary, bowel, sexual domains and satisfaction were evaluated.

Complete responses to the questionnaire were obtained from 131/152 patients receiving RARP, 87/121 patients receiving IMRT, 50/93 patients receiving brachytherapy with EBRT. Table 1 showed patients characteristics. Patients in Group C had higher clinical stage and higher Grison score compared to other groups.
For urinary summary score, Group A was lower than the other groups within 12 months after treatment, but there was no significant difference after 18 months.
For urinary function and bother, Group A was lower than the other groups until the 12 months, but improved after 18 months. This may affect improving urinary incontinence.
For the Bowel summary score, all groups declined in after one month, but then improved. Then it was significantly higher in Group A compared to the other groups. Group A improved to the same extent as before the treatment, but the other groups were lower than before the treatment. For Bowel function and bother were lower after one month in all Groups. Group A was improved over the time thereafter, but the other two Groups remained lower than before treatment.
For satisfaction, there was no significant difference in all Groups.

This study demonstrated that the QOL after RARP was inferior at 1 month compared with radiotherapy, however, the QOL subsequently improved, and was better than in radiotherapy patients’ after 6 months. These findings could help to select treatment for localized prostate cancer and provide information to support decision-making by patients and healthcare professionals.

Our study suggested that QOL was inferior at 1 month after RARP, however, recovered at 12 months after RARP and was better than IMRT and brachytherapy combined with EBRT. These difference in urinary and bowel QOL should be considered in selecting the treatment.