Longitudinal Changes in Illness Acceptance, Psychological Adjustment, and Quality of Life After Robot-Assisted...

Background: Prostate cancer is one of the most commonly diagnosed cancers in men. Robot-assisted radical prostatectomy (RARP) is one of the recommended surgical treatment options; however, knowledge regarding changes in illness acceptance, psychological adjustment, and quality of life after surgery remains limited. Objective: To evaluate changes in illness acceptance, psychological adjustment, and quality of life in patients undergoing RARP. Materials and Methods: A total of 150 patients diagnosed with prostate cancer and scheduled for RARP were enrolled. Longitudinal analysis was performed in 93 patients who completed both study assessments. Evaluations were conducted before surgery and 3-4 months postoperatively using a self-developed questionnaire, the Acceptance of Illness Scale (AIS), the Mini-Mental Adjustment to Cancer (Mini-MAC), the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), and the prostate cancer-specific module (EORTC QLQ-PR25). Results: Following RARP, illness acceptance did not change significantly after Holm adjustment (p_Holm = 0.465). Psychological adjustment showed an adverse postoperative pattern, characterised by increased anxious preoccupation, helplessness-hopelessness, and destructive style, together with reduced fighting spirit and constructive style. After adjustment across 25 paired outcome comparisons, significant increases remained in emotional and cognitive functioning scores, while constipation and diarrhoea decreased significantly. Sexual activity also decreased significantly after surgery. Among participants who completed both assessments, incontinence-aid use increased from 15/93 (16.1%) before surgery to 38/93 (40.9%) at follow-up (exact two-sided McNemar test, p < 0.001). Conclusions: During the early postoperative period following RARP, favourable changes were observed in selected quality-of-life scores, whereas illness acceptance did not change significantly after adjustment for multiple comparisons. At the same time, psychological adjustment showed an adverse pattern, characterised by reduced fighting spirit and constructive style together with increased anxious preoccupation, helplessness-hopelessness, and destructive style. Decreased sexual activity and increased incontinence-aid use further illustrate the multidimensional nature of early postoperative recovery. These exploratory findings indicate that favourable changes in selected quality-of-life outcomes do not necessarily coincide with improved psychological adaptation and support the inclusion of psycho-oncological assessment and support in postoperative care.