Prostate cancer patients, who are scheduled for robot-assisted radical prostatectomy (RARP), often have a history of transurethral resection or laser enucleation of the prostate (TUR/LE-P) as treatment of benign prostate hyperplasia (BPH). We examined if these patients have impaired surgical, functional and oncological outcomes compared to those who have no symptom burden of moderate to severe BPH and no previous TUR/LE-P.
We compared 368 RARP patients with previous TUR/LE-P (Group A) to 4,945 RARP patients without TUR/LE-P and without moderate or severe BPH symptoms (Group B) in a high-volume RARP center. Multivariable cox regression analyses (MVA) assessed impact of TUR/LE-P on erectile function and urinary continence recovery, biochemical recurrence (BCR) or metastatic progression (MP). Analyses were repeated after propensity score matching (PSM).
No relevant differences of surgical outcomes such as surgical margin and 30d complications rates were observed. Urinary continence recovery rates at 12 months were 67 vs. 74% (A vs. B; p <0.001). Erectile function recovery rates at 24 months were 52 vs. 62% (p <0.001). BCR-free rates at 36 months were identical, 87.3 vs. 87.8%. Before and after PSM, TUR/LE-P negatively affected erectile function recovery (matched HR 0.68, 95% CI 0.53-0.88; p=0.003) in MVA. Similarly, TUR/LE-P had negative effect on urinary continence recovery (HR 0.84 95% CI 0.73-0.97; p=0.015) but no effect on BCR and MP.
Previous TUR/LE-P does not negatively impact surgical, complication-related, and oncological outcomes if the RARP is performed by highly experienced surgeons. However, TUR/LE-P negatively affects erectile function and urinary continence recovery.