Functional and perioperative outcomes in elderly men after robotic-assisted radical prostatectomy for prostate cancer
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ORIGINAL ARTICLE
Functional and perioperative outcomes in elderly men after robotic‑assisted radical prostatectomy for prostate cancer Samer L. Traboulsi1 · David‑Dan Nguyen2 · Ahmed S. Zakaria1 · Kyle W. Law2 · Hanna Shahine1 · Malek Meskawi1 · Cristina Negrean1 · Pierre I. Karakiewicz1 · Assaad El Hakim3 · Kevin C. Zorn1 Received: 5 September 2019 / Accepted: 19 January 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose We aimed to compare postoperative functional outcomes following robotic-assisted radical prostatectomy (RARP) in elderly men with localized prostate cancer. Methods A retrospective review of a prospectively maintained database of men who underwent RARP between January 2007 and November 2018 was performed. Patients over 65 years of age were selected (N = 302) and then stratified by age group: 66–69 years old (N = 214) and ≥ 70 years old (N = 88). Full continence was defined as strict 0-pad per day usage. Preoperative potency included those with a Sexual Health Inventory for Men score ≥ 17. Preoperative and postoperative functional outcomes were assessed. Kaplan–Meier analysis was used to estimate time to recovery of continence in both groups. Results Both groups had comparable preoperative parameters. Continence rates at 1, 3, 6, 9, 12, 18 and 24 months in the 66–69-year-old group were 6%, 34%, 61%, 70%, 74%, 80% and 87%, respectively. Comparatively in the ≥ 70-year-old group, continence rates were significantly lower at all time points (3%, 22%, 50%, 56%, 66%, 69% and 75%, respectively). Men in the 66–69-year-old group were significantly more likely to be continent after RARP when compared to patients 70 years of age and above [(Hazards ratio (HR) 0.73; 95%confidence interval 0.54–0.97, (p = 0.035)]. Conclusion Our results suggest that RARP is feasible in elderly patients. Nevertheless, elderly patients in the ≥ 70-year-old group had significantly inferior postoperative continence rates compared to patients aged 66–69 years. Such information is valuable when counselling men during preoperative RARP planning to ensure that they have realistic postoperative expectations. Keywords Prostate cancer · Robotic-assisted radical prostatectomy · Outcomes · Continence · Potency
Introduction Prostate cancer (PCa) is the most prevalent cancer in Canadian men [1]. It is predominantly a disease of the elderly with 64% of new cases diagnosed in men aged ≥ 65 years and 23% in men aged ≥ 75 years [2].
* Kevin C. Zorn [email protected] 1
Division of Urology, Department of Surgery, Centre hospitalier de l’université de Montréal (CHUM), Montreal, QC, Canada
2
Faculty of Medicine, McGill University, Montreal, QC, Canada
3
Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Coeur de Montréal, Montreal, QC, Canada
Over the last two decades, robotic-assisted radical prostatectomy (RARP) has gained importance in the surgical management of prostate cancer worldwide. This minimally invasive procedure harbors several advantages for patients su
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