Objectives: Decision to undergo radical prostatectomy (RP) for treatment of prostate cancer (PCa) can have a significant impact on a patient's quality of life (QoL) and functional outcomes (FO), sometimes leading to decision-regret after surgery. The objective of this review was to understand how decision regret is assessed and its relationship with QoL and FO in patients who underwent laparoscopic or robot-assisted RP for PCa.
Methods: Structured literature review using Web of Sciences and PubMed, including all articles with the association between the following keywords: “prostate cancer”, “radical prostatectomy”, “RALP”, “laparoscopic radical prostatectomy “, “RARP” AND “decision regret”, “DRS”, “QoL”, “functional outcomes”, “EORTC”, “SF-36”, “EPIC” from inception to present. 14 articles were included in the literature review, selected based on the criteria seen in table 1.
Results: The most common scoring system used to assess decision-regret was the decision regret scale (DRS) (8 of 14; one study used a modified 1-Item DRS). Categorical scoring for high level of decision-regret ranged from >15 to >25. The mean DRS score amongst the 6 studies that provided values was 14.17 (SD 1.31; 95% CI 10.78-17.55). The remaining studies used other validated decision-regret scoring systems such as Clark et al.’s. Overall, the studies reported varying levels of decision-regret, with most finding low levels of regret (table 2). QoL and FO were assessed using a variety of scoring systems, the most common including the EORTC QLQ-C30, EORTC PR25, Expanded Prostate Cancer Index Composite (EPIC) and 36-item Short Form Health Survey (SF-36). Most of the studies found that higher levels of decision-regret were associated with worse QoL/FO, particularly in the domains of sexual and urinary function (table 3).
Conclusions: The relationship between decision regret, QoL and FO is complex and multivariate. Further research should focus on ways to minimize decision regret and improve QoL and FO.