To provide insights into the long-term impact of radical retro-pubic prostatectomy (ORRP) on lower urinary tract symptoms (LUTS) which are age and prostate dependent and adversely impact quality of life.

1995 men undergoing ORRP enrolled in a prospective longitudinal outcomes study. The American Urological Association Symptom Index was self-administered before ORRP and at predetermined time-points after surgery. A multivariate generalized linear model was used to evaluate the association of time since ORRP with American Urological Association symptom score (AUASS). McNemar's test and paired sample t-tests were used to assess whether the proportion of men with clinically significant LUTS (CSLUTS) defined by an AUASS >7 or mean AUASS differed significantly between the time-dependent assessments, respectively.

The 15-year mean adjusted AUASS was similar to baseline (7.00 vs 6.85, P = .66). Throughout the 15 years of follow-up, the proportion of men with CSLUTS was lower than baseline with the exception of the 3 month and 15 year assessments. Among men with baseline clinically insignificant LUTS (CILUTS), the mean adjusted AUASS at 15 years was significantly greater than baseline (6.09 vs 3.19, P < .001). Among men with baseline CSLUTS, ORRP led to a significant decrease in mean adjusted AUASS between baseline and 15 years (13.26 vs 8.67, P < .001).

ORRP favorably affects the long-term natural history of LUTS. The long-term economic and quality of life benefits of ORRP on LUTS should inform the risks and benefits of RP for treatment of localized prostate cancer.