Exploring patient decision regret following robot-assisted radical prostatectomy: a prospective cohort study

There exists a paucity of evidence within Australia relating to rates and predictors of postoperative decision regret in patients undergoing Robot-Assisted Radical Prostatectomy. This study reports rates of decision regret up to 1 year postoperatively and aims to identify predictors of postoperative decision regret. The secondary aim is to test an association between participant's decision regret with surgical, functional and quality of life outcomes.

This study included patients undergoing Robot-Assisted Radical Prostatectomy between 2016 and 2023 at a major tertiary hospital in Sydney. Regret was measured using the Decision Regret Scale, with scores > 25 indicating high level of regret. Associations between decision regret and surgical, functional and quality-of-life outcomes were explored using univariate and multivariate logistic regressions.

In total, 242 participants were included. Mean decision regret scores were similar at 6 weeks (20.3 ± 20.6), 3 months (22.5 ± 22.6), and 1 year (21.5 ± 22.5) postoperatively. Most participants' decision regret remained within their high or low regret group across all three postoperative timepoints. Participant reported measures of greater pain, urinary, sexual, bowel, hormonal symptoms and worse quality of life were all significantly different between high and low regret groups. Poor preoperative mental health was significantly associated with higher 6 week postoperative decision regret, suggesting a potential predictive relationship.

Most participants reporting high or low decision regret following Robot-Assisted Radical Prostatectomy maintain this regret up to 1 year postoperatively. Future studies should corroborate and investigate interventions to reduce participant decision regret.