Comment on "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

The recent meta-analysis by Liu et al. comparing postoperative functional complications and quality of life (QoL) between robot-assisted radical prostatectomy (RARP) and radiotherapy (RT) in localized prostate cancer raises important clinical questions but is constrained by methodological and interpretative limitations. Our commentary identifies four key issues: (1) inadequate adjustment for baseline confounding factors such as age, comorbidities, and androgen deprivation therapy exposure; (2) unstandardized aggregation of patient-reported outcome measures (PROMs), impairing statistical comparability; (3) absence of modality-specific stratification within the RT group, which combines external beam and brachytherapy despite differing toxicity profiles; and (4) overinterpretation of functional outcome trends without accounting for follow-up duration and evolving surgical techniques. These issues undermine the validity of the authors' conclusions regarding RT's superiority in functional recovery. We argue that future comparative effectiveness research should employ harmonized PROM frameworks, robust causal inference methodologies, and biologically stratified cohort analyses. Our critique underscores the need for precise, individualized assessment in treatment decision-making for localized prostate cancer and supports the broader scientific imperative for methodologically sound patient-centered outcomes research in robotic and radiotherapeutic oncology.