Comprehensive Assessment of Postoperative Quality of Life and Risk Factors After Robot-Assisted Radical Prostatectomy Using the EPIC Questionnaire

Background: Robot-assisted radical prostatectomy is a standard treatment for localized prostate cancer. This procedure provides favorable oncologic outcomes but poses functional challenges, particularly urinary incontinence and sexual dysfunction, that can affect patients’ quality of life (QOL). This study examined predictive factors for postoperative recovery of urinary, sexual, and bowel functions using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire. Methods: This single-center retrospective study included 279 patients with clinically localized prostate cancer who underwent RARP between 2011 and 2023. Health-related QOL was assessed preoperatively and up to 18 months postoperatively using the EPIC questionnaire. Recovery was defined as achieving ≥ 90% of baseline scores at 18 months. Logistic regression analyses were conducted to identify independent predictors of poor recovery. Results: Urinary function improved gradually, but 39.8% of patients showed suboptimal recovery at 18 months. In multivariable analysis, console time was an independent risk factor for poor urinary incontinence recovery (odds ratio: 1.85, 95% confidence interval: 1.01–3.45, p = 0.04). Age, body mass index, and prostate volume were not significantly associated, likely because of routine preoperative pelvic floor training. Younger patients reported greater dissatisfaction with postoperative sexual function despite higher baseline scores. Bilateral nerve-sparing was associated with improved sexual function recovery, although the small sample size limited interpretation. Bowel function remained stable. Conclusion: Prolonged console time was associated with delayed urinary continence recovery, emphasizing the role of surgical proficiency. Younger patients were more likely to experience postoperative dissatisfaction with sexual outcomes, underscoring the importance of age-specific counseling and individualized perioperative care.