Postoperative functional complications and quality of life following robot-assisted prostatectomy and radiotherapy in localized prostate cancer: evidence from a systematic review and meta-analysis.

Abstract

To compare patient-reported functional outcomes and health-related quality of life (QoL) after robot-assisted radical prostatectomy (RARP) and radiotherapy (RT) for localised prostate cancer. We systematically searched PubMed, EMBASE, the Cochrane Library and Web of Science (inception to 10 January 2025). Comparative studies reporting urinary, bowel or sexual outcomes were eligible. Pooled relative risks (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Study quality was assessed with the Newcastle-Ottawa Scale. Seven studies comprising 6 133 men (3625 RARP: 2508 RT) met the inclusion criteria. RARP was associated with significantly higher risks of urinary incontinence (RR = 5.19, 95% CI: 2.03-13.25; P = 0.007) and erectile dysfunction (RR = 1.69, 95% CI: 1.06-2.68; P < 0.05) compared to RT. Functional outcomes favored RT in urinary bother reduction (WMD = -9.04, 95% CI: -17.80 to -0.29), although no significant intergroup differences emerged in bowel domain scores. RT demonstrated superior preservation in sexual function (WMD = -5.91, 95% CI: -8.67 to -3.15), while maintaining comparable fecal urgency rates (RR = 0.42, 95% CI: 0.38-0.48). RT demonstrated superior post-treatment QoL profiles in multiple functional domains compared to RARP for localized prostate cancer, particularly regarding urinary continence and sexual health preservation. These findings can guide shared decision-making regarding treatment choice.