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Oncological and functional outcomes in patients over 70 years of age treated with robotic radical prostatectomy: a propensity-matched analysis

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Abstract

Purpose

The aim of this study was to report on the safety (complications) and efficacy (oncological and functional outcomes) of robot-assisted radical prostatectomy (RARP), performed at our institution, in patients aged over 70.

Patients and methods

Review of our prospectively collected database [Cancer Information Systems (CAISIS)] identified two hundred and fifteen (215) patients, aged > 70, who underwent RARP for localized prostate cancer between July 2003 and August 2017. A propensity score-matched analysis, with multiple covariates, was performed to stratify the patients into Age ≤ 70 and Age > 70 comparison groups.

Results

Apart from Age (mean ± SD years: 73.5 ± 2.1 vs 59.5 ± 5.9, p < 0.0001) and nerve-sparing status, the two groups were evenly matched for all covariates (p values > 0.05). Median follow-up was 10.6 years. There were no 90-day mortalities in either group. Minor complications (Clavien ≤ 2) were more common in the Age > 70 group (p = 0.0002). Operating room time (p = 0.83), length of hospital stay (p = 0.06) and catheterization duration (p = 0.13) were similar. On final pathology, a higher pT stage (p < 0.0001) and pN1 (p = 0.003) were observed in the Age > 70 group. However, this did not translate adversely into higher rates of positive surgical margin (p = 0.41) or biochemical relapse (p = 0.72). Allowing for the follow-up duration (median 10.6 years), cancer-specific survival was marginally significant (p = 0.05) with an observed lower rate in the Age > 70 group. In terms of functional outcomes, post-operative erectile dysfunction and pad-free continence were significantly better in the younger cohort (p < 0.0001).

Conclusions

Robot-assisted radical prostatectomy should not be denied to those over 70 years solely on the basis of age. Older men need to be counseled about the likelihood of encountering higher-risk features on final pathology and that their functional outcomes may be worse compared to a younger person.

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Acknowledgements

The authors thank Bonita Powell for CAISIS database management.

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Authors and Affiliations

  1. Department of Urology, University of Rochester Medical Center, New York, USA

    Pratik M. S. Gurung, Stephen Hassig, Jasmine Wood, Elizabeth Ellis, Ahmed E. Ghazi & Jean V. Joseph

  2. Department of Biostatistics and Computational Biology, University of Rochester Medical Center, New York, USA

    Bokai Wang & Changyong Feng

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  1. Pratik M. S. Gurung
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Contributions

Protocol/project development: PG, JJ. Data collection/management: PG, SH, JW, EE. Data analysis: BW, CF, PG. Manuscript writing: PG. Manuscript editing: PG, CF, AG, JJ.

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Correspondence to Pratik M. S. Gurung.

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The study was approved by the institutional review board (IRB).

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Electronic supplementary material

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Supplementary Figure S1:

Urinary and Sexual Function Questionnaire (TIFF 3708 kb)

Supplementary Figure S2:

Intra-operative data capture (TIFF 2614 kb)

Supplementary Figure S3.

Sub-analysis of the whole cohort: K–M plots demonstrating differences in (A) cancer-specific survival and (B) overall survival between the ASA ≤ 2 and ASA > 2 groups (TIFF 1669 kb)

Supplementary Figure S4.

Sub-analysis of (A) Cancer-specific survival and (B) Overall survival within the Age > 70 cohort stratified by Age≤75 and Age > 75 (TIFF 1739 kb)

Supplementary Figure S5.

Sub-analysis of Functional outcomes: Erectile function - Comparison of post-operative IIEF5 scores after adjustment for nerve sparing status (TIFF 2041 kb)

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Gurung, P.M.S., Wang, B., Hassig, S. et al. Oncological and functional outcomes in patients over 70 years of age treated with robotic radical prostatectomy: a propensity-matched analysis. World J Urol 39, 1131–1140 (2021). https://doi.org/10.1007/s00345-020-03304-x

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