Safety, Efficacy, and Impact on Quality of Life of Palliative Robotic Cystectomy for Advanced Prostate Cancer

Objectives To report surgical outcomes, palliative durability, and quality of life (QOL) after palliative robotic cystectomy (RC) for symptomatic advanced prostate cancer (PC). Methods Retrospective review of patients who underwent RC (n=10) at our institution from 2013-2018. European Organization for Research and Treatment of Cancer (EORTC) Functional Assessment of Cancer Therapy – Bladder Cystectomy (FACT-BL-CYS) questionnaire was administered to assess QOL. Patient characteristics, peri-operative outcomes, changes in pre-operative symptoms, and FACT-BL-CYS scores were assessed post-operatively. Results Mean age was 70 years (IQR, 64-72), and median follow up was 505 days. Five patients (50%) had prior radiation therapy (RT). Rates of perioperative and delayed complications were 30% and 30%, respectively. There were no cases of rectal injury. At latest follow up, there were no cases of urinary obstruction, hematuria, or pelvic pain, and 80% of patients remained symptom free. Six of ten patients responded to the questionnaire and completed the FACT-BL-CYS. Individual sub-domain scores (physical, social, functional, emotional, bladder specific) and overall scores were similar to post-operative radical cystectomy populations in other studies. 100% of responding patients would repeat RC. Conclusion RC appears to be a safe and effective option for advanced PC refractory to other interventions. The majority of patients would repeat the procedure. However, given the differences in goals of care for patients undergoing surgery for curative intent vs for palliation, we lack the ability to make true inferences regarding measurable improvements in quality of life; this highlights the need for high quality multi-institutional studies to better understand the impact of RC on QOL.