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.
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).
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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The authors thank Bonita Powell for CAISIS database management.
Conflict of interest
The authors have no conflicts of interest to declare.
The study was approved by the institutional review board (IRB).
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Electronic supplementary material
Below is the link to the electronic supplementary material.
Urinary and Sexual Function Questionnaire (TIFF 3708 kb)
Intra-operative data capture (TIFF 2614 kb)
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)
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)
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 (2020). https://doi.org/10.1007/s00345-020-03304-x
- Radical prostatectomy
- Prostate cancer
- Robotic surgery