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

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.

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.

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, p < 0.001; impotence estimate: 5.4 ± 2.3, p = 0.02).

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.