Impact of Preoperative LUTS on Health-related Quality of Life Following Radical Prostatectomy: A Propensity Score Matched Longitudinal Study

Thilo Westhofen; Enya Feyerabend; Alexander Buchner; Boris Schlenker; Armin Becker; Lennert Eismann; Severin Rodler; Friedrich Jokisch; Christian G Stief; Alexander Kretschmer

doi:10.1016/j.urology.2024.04.020

Impact of Preoperative LUTS on Health-related Quality of Life Following Radical Prostatectomy: A Propensity Score Matched Longitudinal Study

Urology. 2024 Apr 26:S0090-4295(24)00289-9. doi: 10.1016/j.urology.2024.04.020. Online ahead of print.

Affiliations

¹ Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany. Electronic address: thilo.westhofen@med.uni-muenchen.de.
² Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany.
³ Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany; Janssen Global Research and Development, Los Angeles, CA.

PMID: 38679296
DOI: 10.1016/j.urology.2024.04.020

Abstract

Objective: To assess the impact of preoperative lower urinary tract symptoms (LUTS) on long-term health-related quality of life (HRQOL) up to 10 years after radical prostatectomy (RP) for prostate cancer (PC).

Methods: Within our prospective institutional database of 6487 patients treated with RP for PC (2008-2020), 2727 patients with preoperative LUTS (IPSS score of ≥8) were identified. A 1:1 propensity-score matched analysis of 3056 men (n = 1528 LUTS, n = 1528 no LUTS) was conducted. Primary endpoint was HRQOL (based on EORTC QLQ-C30 and PR25). Linear regression models tested the effect of preoperative LUTS on the net change in general HRQOL (P <.05).

Results: Median follow-up was 48 months. Preoperative mean global health status (GHS) score (67.4 vs 75.7) was significantly lower in the LUTS cohort (P <.001). Post-RP the difference in general HRQOL between the LUTS cohort and the no-LUTS cohort became smaller (65.7 vs 67.8), however, remaining statistically significant (P = .037). In long-term follow-up, general HRQOL was comparable between both subcohorts (P-range 0.716-0.876). Multivariable linear regression analysis revealed increased preoperative IPSS as an independent predictor for increased perioperative improvement of IPSS (P <.001) CONCLUSION: For patients undergoing RP, preoperative LUTS were associated with a postoperative improvement of HRQOL outcomes. In long-term follow-up, HRQOL was comparable to patients without preoperative LUTS. Hence, RP is an efficient option to treat PC as well as LUTS in those patients.