Background <p>Robot-assisted radical prostatectomy (RARP) 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.</p> Methods <p>This single-center retrospective study included 279 patients 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. Firth’s penalized logistic regression and baseline-adjusted analyses were performed to identify factors associated with poor recovery.</p> Results <p>Urinary function improved gradually, but 39.8% of patients showed suboptimal recovery at 18 months. In multivariable Firth’s penalized logistic regression analysis, longer console time was independently associated with poor urinary incontinence recovery (OR 2.15, 95% CI 1.14–4.17). Ratio-based analyses suggested age-related differences in sexual recovery; however, baseline-adjusted analyses demonstrated a dissociation between postoperative sexual function and sexual bother. Nerve-sparing status was not independently associated with urinary and sexual recovery. Bowel function remained stable.</p> Conclusion <p>Longer console time was independently associated with poorer recovery of urinary continence after RARP, likely reflecting surgical complexity rather than a direct causal effect. Baseline-adjusted analyses revealed a dissociation between postoperative sexual function and sexual bother, underscoring the limitations of function-based QOL assessment and the need for patient-centered counseling and shared decision-making in RARP.</p>