BACKGROUND: The aim of this study was to evaluate the perioperative oncological and functional outcomes after robot-assisted radical prostatectomy (RALP) in older men.
PATIENTS AND METHODS: The records of n = 2,000 men who underwent RALP from February 2006 to April 2010 were retrospectively reviewed. A total of 45 patients ≥ 75 years were indentified. Subsequently this subgroup was compared to the overall patient cohort with regard to perioperative results, pathological tumor stage, functional outcomes after 12 months and the prostate cancer-specific mortality and biochemical recurrence free survival.
RESULTS: The following results reflect the comparison of the cohort of patients who were ≥75 years of age versus the overall cohort of patients. A statistical difference of the parameters analyzed was observed only for minor complications 15.5 % versus 11.4 % (p< 0.05), neurovascular bundle (NVB) preservation 51.1 % versus 65.7 % (p< 0.05) and potency after 12 months 39.6 % versus 66.2 % (p< 0.001). Major complications were noted in 2.2 % versus 1.3 % of cases. A Gleason score < 7 was noted in 37.4 % versus 42.8 %, a Gleason score 7 in 51.1 % versus 47.7 % and a Gleason score >7 in 11.6 % versus 9.5 %. Tumor stages pT2 and pT3 were noted in 68.8 % versus 73.5 % and in 31.2 % versus 25.2 %, respectively. The positive surgical margin status was encountered in 11.1 % versus 8.9 % of cases, respectively. At 12 months 86.9 % versus 92.8 % of patients were continent and 39.6 % versus 66.2 % were potent, respectively. After a median follow-up of 17.2 months the prostate cancer-specific mortality in the subgroup of elderly patients was 0 % and the biochemical recurrence-free survival was 95.5%.
CONCLUSIONS: The RALP approach in patients ≥75 years of age is a safe surgical procedure with a limited complication rate, excellent oncologic and continence outcomes as well as acceptable erectile function. Nevertheless, RALP should be limited to a selected cohort of patients with a good health status and an individual life expectancy of more than 10 years. For the assessment of the final oncological benefits of RALP in this patient population a longer follow-up is necessary.
Written by:
Porres D, Pfister D, Labanaris AP, Zugor V, Witt JH, Heidenreich A. Are you the author?
Klinik und Poliklinik für Urologie, Universitätsklinikum der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
Reference: Urologe A. 2012 Oct;51(10):1424-31.
doi: 10.1007/s00120-012-2925-3
PubMed Abstract
PMID: 23053039
Article in German.
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