Background: We investigate patient-reported recovery of urinary and bowel function of patients after radical retropubic prostatectomy (RRP), radical perineal prostatectomy (RPP), laparoscopic robotic prostatectomy (LRP) and cryosurgical ablation of prostate (CAP) using the Expanded Prostate Cancer Index Composite (EPIC) .

Methods: Two hundred fifty-two men scheduled to undergo surgical prostatectomy for clinically organ-confined prostate cancer between 2001 and 2006 were prospectively enrolled in an ongoing prospective study of functional and health-related quality of life outcomes. Of the analyzed cases, the distribution was as follows: 32 (12.7%) RRP, 109 (43.2%) RPP, 86 (34.1%) LRP and 25 (10.0%) CAP. All patients completed the EPIC with objective, subjective, and overall function score of urinary and bowel domains at baseline prior to surgery and at 3,6,9 and 12 months of followup. EPIC reports were analyzed using descriptive statistics, chi-square analysis and non-parametric ANOVA with SPSS software (Chicago, IL, version 14).

Results: Patients undergoing CAP of mean age 67±7 years were significantly older than those undergoing RRP (60 ±6, p=0.03), RPP (60 ±7, p=0.04) and LRP (59 ±7, p<0.0005). CAP group had a median ASA score of 3 compared to all other groups having a median ASA score of 2 (p<0.0005).The mean LOS in the CAP group was significantly lower (0.1± 0.1, median- 0 days) (only 2 procedures of 25 were done on in-patient basis) than that for RRP (2.8±1.6, median-3 days), RPP (3.3±1.9, median-2 days), and LRP (2.2±1.4, median-2 days) (p=0.01). At baseline, there were no differences between the 4 treatment groups. At 3 months follow-up, the overall urinary function score was higher in the CAP group, 80.7±21.1 compared to 60.0±21.6 after RRP, 69.0±20.0 after RPP and 70.3±19.2 after LRP (p=0.006). Significant differences between subjective, objective scores and urinary incontinence score were demonstrated favoring CAP. There were no differences revealed between CAP and other surgical groups regarding scores for bowel function.

Conclusions: This single-institutional data suggests that urinary function improved faster (up to 3 month) following CAP compared to other surgical prostatectomies. CAP may be a more appealing therapy to those men who wish to preserve their pre-treatment urinary function.