Impact of Cosmetic Result on Selection of Surgical Treatment in Patients With Localized Prostate Cancer

Abstract

Objectives:To analyze the effect of cosmetic outcome as an isolated variable in patients undergoing surgical treatment based on the incision used in the 3 variants of radical prostatectomy: open (infraumbilical incision and Pfannestiel incision) and laparoscopic, or robotic (6 ports) surgery.Patients and methods:612 male patients 40 to 70 years of age with a negative history of prostate disease were invited to participate. Each patient was evaluated by questionnaire accompanied by a set of 6 photographs showing the cosmetic appearance of the 3 approaches, with and without undergarments.Participants ranked the approaches according to preference, on the basis of cosmesis. We also recorded demographic variables: age, body mass index, marital status, education level, and physical activity.Results:Of the 577 patients who completed the questionnaries, the 6-port minimally invasive approach represents the option preferred by 52% of the participants, followed by the Pfannestiel incision (46%), and the infraumbilical incision (11%), respectively. The univariate and multivariate analyses did not show statistically significant differences when comparing the approach preferred by the patients and the sub-analyses for demographic variables, except for patients who exercised who preferred the Pfannestiel incision (58%) instead of minimally invasive approach (42%) with statistically significant differences.Conclusion:The minimally invasive approach was the approach of choice for the majority of patients in the treatment of prostate cancer. The Pfannestiel incision represents an acceptable alternative. More research and investment may be necesary to improve cosmetic outcomes.

Impact of Robotic Technologies on Prostate Cancer Patients’ Choice for Radical Treatment

“…Specifically, Schroeck et al [ 16 ], through the administration of a surgical expectation questionnaire to 187 patients undergoing RARP or LaRP, showed how patients who underwent RARP expected a significantly shorter length of hospital stay (OR 0.07, p < 0.001), earlier return to physical activity (OR 0.36, p = 0.005), and, particularly, a better erectile function (EF) recovery. Another study conducted in 2014 by Egui Rojo et al [ 17 ] analyzed the effect of cosmetic outcome in patients undergoing surgical treatment regarding three variants of RP: oRP (infraumbilical incision and Pfannenstiel incision), LaRP, and RARP; the study consisted of questionnaires accompanied by photographs showing the cosmetic results of these three approaches. Among the 577 patients, the majority (52%) preferred the minimally invasive approach consisting of the six-robotic-port surgery for the treatment of PCa.…”

Patient driven care in the management of prostate cancer: analysis of the United States military healthcare system

“…Previous studies among men with prostate cancer have demonstrated patient preferences for various treatment options for prostate cancer (e.g. active surveillance, surgery, radiation, or hormonal therapy) [ 17 – 19 ], cosmetic results of different types of prostatectomies [ 20 ] and on functional outcomes (erectile function and continence) [ 21 ]. Our results expand on this pre-existing body of work, and demonstrate that patient preferences indeed induce a demand for greater utilization of healthcare services, which could feasibly impact the overall burden of disease.…”

Câncer de próstata: diagnóstico e terapêuticas

“…Dentre as técnicas supracitadas, destaca-se a prostatectomia radical robótica (PRR), que configura o mais recente avanço no tratamento cirúrgico do câncer de próstata, considerada como padrão-ouro no tratamento cirúrgico do câncer de próstata, baseada na abordagem cirúrgica minimamente invasiva da prostatectomia laparoscópica, otimizada pela tecnologia robótica. A PRR possui como objetivos gerais: manutenção dos benefícios da cirurgia minimamente invasiva e, ao mesmo tempo, maximizar o controle do câncer, preservar a continência urinária (capacidade de controlar voluntariamente liberação da urina), função erétil; diminuição do tempo operatório, minimizando o tempo de hospitalização; redução da perda sanguínea, que é significativamente menor em comparação às demais técnicas; menor duração do cateterismo vesical, dentre outros benefícios (ABBOU, 2001;ROJO, 2014;XU;DAILEY, 2011, MEDEIROS et al, 2023.…”