A Randomized Trial of Multimodal Prehabilitation Before Robotic-Assisted Radical Prostatectomy to Improve Postoperative Quality of Life and Functional Outcomes

PURPOSE: Robotic-assisted radical prostatectomy (RARP) causes postoperative impairments. Although prehabilitation has shown benefits in surgical populations, data specific to RARP remain limited. We evaluated whether multimodal prehabilitation improves early postoperative health-related quality of life (HRQoL), functional recovery and mental health. MATERIALS AND METHODS: Prospective, single-center randomized trial including men with prostate cancer scheduled for RARP (May 2022- September 2024). Participants were randomized to a 4-week multimodal prehabilitation program including physical and pelvic floor muscle training, nutritional counselling and psychological support or to usual care. The primary outcome was change in the EORTC QLQ-C30 global health status score from baseline to 1 month after surgery. Secondary endpoints included functional and perioperative outcomes at 1, 3 and 6 months. RESULTS: Ninety-five of 100 randomized patients were analyzed (53 prehabilitation, 42 control). At 1-month post-operatively, global health status score was higher in the prehabilitation group (adjusted mean difference +15 points, 0-100 scale; 95% confidence interval (CI) 7-22; p<0.001). Improvements at 1-month were also observed in several HRQoL domains, mental health and urinary continence (mean difference in ICIQ-UI SF -2.7; p=0.032). No differences were detected in physical performance or erectile function. Prehabilitation benefits attenuated over time, with the global health status difference decreasing to +4.5 points at 6 months (-1.9 points/month; p = 0.024), whereas improvements in selected HRQoL domains, mental health, and ICIQ-UI SF were maintained throughout follow-up. CONCLUSIONS: Multimodal prehabilitation before RARP is feasible and should be integrated into clinical practice, as it enhances postoperative recovery and patient-centered outcomes.