The comparison of post-treatment quality of life after at least two years of follow-up (≥ 24 months) between robotic radical prostatectomy and radiotherapy for intermediate-risk localized prostate cancer

Background Robot-assisted laparoscopic radical prostatectomy (RALRP) and intensity-modulated radiotherapy (IMRT) are the main curative options for localized prostate cancer (PCA). However, both may significantly affect patients’ quality of life (QoL). Objective To retrospectively compare post-treatment QoL after at least 24 months of follow-up between bladder-neck- and nerve-sparing RALRP and IMRT in patients with intermediate-risk localized PCA. Methods A total of 164 patients treated between October 2016 and May 2023 were analyzed (104 RALRP; 60 IMRT). QoL was evaluated using the Expanded Prostate Cancer Index Composite (EPIC-2002). Urinary, bowel, sexual, and hormonal domains were compared using appropriate statistical tests . Results Baseline demographics were similar between groups. The mean age was 68.82 ± 6.72 years in the RALRP group and 68.89 ± 7.81 years in the IMRT group. IMRT patients reported better sexual function ( p < 0.05), but this advantage was counteracted by hormonal side effects due to androgen deprivation therapy (ADT). Urinary continence was comparable ( p > 0.05), whereas irritative urinary symptoms were more common in IMRT ( p < 0.001). Bowel function and overall satisfaction were significantly better in RALRP (both p < 0.001). Conclusions After ≥ 24 months of follow-up, RALRP provided superior bowel and hormonal outcomes, while IMRT yielded slightly better sexual function scores. Overall satisfaction favored RALRP.