Quality of Life in Prostate Cancer Patients Following Radical Prostatectomy: A Systematic Review and Meta-Analysis

摘要

OBJECTIVE: Quality of life (QoL) is a key outcome for assessing the effectiveness of treatment and surgical techniques. Radical prostatectomy (RP) impacts QoL in both psychological and physical aspects. This systematic review and meta-analysis aim to evaluate QoL changes in prostate cancer patients before and after RP. METHODS: PubMed, EMBASE, and the Cochrane Central Register were searched for studies on PCa patients undergoing RP, with QoL assessed using EORTC QLQ-C30 and/or QLQ-PR25 questionnaires before and one year after surgery. Primary outcomes included overall QoL with open and laparoscopic robotic/hand-assisted RP. Secondary outcomes covered emotional, social, and sexual functioning, urinary symptoms, and pain. Statistical analysis was performed using Review Manager 5.3, following PRISMA guidelines. RESULTS: A total of 14 studies were incorporated. Overall QoL significantly improved one year after RP (SMD = -0.14; 95%CI [-0,21 - 0,07]; p<0.0001). Laparoscopic/robotic-assisted RP showed statistically significant QoL improvement (SMD = -0.11; 95%CI [-0,15 - 0,07], p<0.0001), while open RP did not (SMD = -0.11; 95%CI[-0,22 - 0,01]; p=0.07). Emotional function improved (SMD = -0.40; 95%CI[-0,49 - 0,31]; p<0.0001), but social function (SMD = 0.07; 95%CI[-0,01 - 0,15]; p=0.09), urinary symptoms (SMD = -0.01; 95%CI[-0,17 - 0,16]; p=0.94), and pain (SMD = 0.01; 95%CI[-0,04 - 0,06]; p=0.70) showed no significant changes. Post-therapy sexual function decreased significantly (SMD = 0.31; 95%CI[0,14 - 0,49]; p=0.0005). CONCLUSION: RP is the gold standard for localized PCa, with a significant impact on QoL. The laparoscopic approach offers better QoL outcomes than open RP, though sexual function, urinary symptoms, and social function show limited improvement.