Robotic-Assisted Radical Prostatectomy in the Elderly Patient-A Study of Functional, Surgical, and Oncological Outcomes in an Australian Cohort.

[BACKGROUND] Curative surgery for prostate cancer is uncommonly offered to patients aged ≥ 75, balancing functional outcomes against survival benefit. The increased adoption of robotic-assisted radical prostatectomy (RARP) and improved overall life expectancy challenges this paradigm. The objective of this study was to compare functional outcomes between elderly and younger patients following RARP.

[METHODS] Retrospective review of a prospective multicentre database including all RARP patients between October 2016 and December 2023. Patients were divided into cohorts based on age; elderly (≥ 75 years) and younger (< 75 years). Variables included baseline demographics (body mass index [BMI], American Society of Anaesthesiologists [ASA] classification, prostate specific antigen [PSA], and Gleason score), surgical (technique, complications, and length of stay), pathological (histopathology, margins, and PSA) and functional (incontinence, International Prostate Symptom Score [IPSS], International Index of Erectile Function [IIEF-5], and Expanded Prostate Index Composite [EPIC]) outcomes. Univariate (chi-square and t-tests) and multivariate analysis were performed to compare cohorts against the primary outcome of continence at 1-year (number of pads/day), with p-values < 0.05 considered statistically significant.

[RESULTS] A total of 397 patients were included (< 75; n = 332, ≥ 75; n = 65). No statistically significant differences were detected in continence at 1-year in ≥ 75 (< 75; 0.73 [0.59-0.87], ≥ 75; 0.66 [0.37-0.95] mean pads/24 h, p = 0.8), despite significantly lower nerve preservation and bladder-neck spare rates (< 75; 37.3%, ≥ 75; 21.5%). IIEF-5 scores were worse in the ≥ 75 group (1.60 ± 1.17 vs. 5.73 ± 6.93 p < 0.001), however there were no significant differences in IPSS. Patient in the elderly cohort had more severe disease (67.7% T3, ≥ 75 vs. 47.3%, < 75, p < 0.05). Rates of positive surgical margins (28.3% vs. 30.8% [≥ 75]) and PSA recurrence (25% vs. 23% [≥ 75]) were similar. Complication rates were low in both groups with no significant differences (3% vs. 6.6% [≥ 75]) and were of lower severity in the ≥ 75 group.

[CONCLUSION] RARP in carefully selected elderly patients does not increase risk of urinary incontinence and should not be disregarded in an aging population with higher overall life expectancy.