Treatment decision regret after precision prostatectomy: An analysis of patient-reported outcomes predicting decision regret.

OBJECTIVES

This study aimed to assess postoperative decision regret (DR) after precision prostatectomy (PP), a novel subtotal surgical technique for prostate cancer (PCa) that involves the preservation of the unilateral capsule and seminal vesicle, and to identify factors predictive of DR after PP.

MATERIALS AND METHODS

After a shared decision-making process, 128 patients underwent PP for the treatment of localised PCa. Given the subtotal nature of the surgery, patients were informed about the possibility of a detectable prostate-specific antigen and secondary treatment. Between 6 and 12 months of follow-up, DR was analysed using the previously validated decision regret score (DRS). A univariable linear regression analysis was performed to analyse factors predictive of DR after PP.

RESULTS

Between 6 and 12 months after PP, objective measurements of DR were obtained on 64 patients who completed the DRS. At the time of DRS, 16 patients were impotent (SHIM < 17), while six were incontinent (≥1 pad/day). The median time to DRS was 10 months (IQR 7.5-11.8). Only two patients (3.1%) reported significant DR after PP (DRS > 25), while 53 patients (83%) reported no regret (DRS = 0). The median DRS was 0 (0-0). Incontinence and impotence at the time of DRS predicted higher DR after PP (incontinence estimate: 11.3 ± 3.2,  < 0.001; impotence estimate: 5.4 ± 2.3,  = 0.02).

CONCLUSIONS

The incidence of DR after PP is low, with only 3% of patients reporting significant regret. Patients who are either incontinent or impotent after PP are more likely to regret their decision. Further studies with larger sizes and longer follow-ups are required to measure the longitudinal trends in DR after PP.