Top

Published in:

01-04-2021 | Prostate Cancer | Original Article

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

Authors: Pratik M. S. Gurung, Bokai Wang, Stephen Hassig, Jasmine Wood, Elizabeth Ellis, Changyong Feng, Ahmed E. Ghazi, Jean V. Joseph

Published in: World Journal of Urology | Issue 4/2021

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.

Available only for authorised users

AUA (2017) Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. http://www.auanet.org/guidelines/prostate-cancer-clinically-localized-(2017). Accessed 7 Jan 2020

EAU G (2017) EAU–ESTRO–ESUR–SIOG guidelines on prostate cancer. https://uroweb.org/wp-content/uploads/09-Prostate-Cancer_2017. Accessed 7 Jan 2020

Kochanek KD, Murphy S, Xu J, Arias E (2017) Mortality in the United States, 2016. NCHS Data Brief 293:1–8

Mariotto AB, Zou Z, Johnson CJ, Scoppa S, Weir HK, Huang B (2018) Geographical, racial and socio-economic variation in life expectancy in the US and their impact on cancer relative survival. PLoS One 13(7):e0201034. https://doi.org/10.1371/journal.pone.0201034CrossRefPubMedPubMedCentral

Ilic D, Evans SM, Allan CA, Jung JH, Murphy D, Frydenberg M (2017) Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer. Cochrane Database Syst Rev 9:Cd009625. https://doi.org/10.1002/14651858.cd009625.pub2CrossRefPubMed

Greco KA, Meeks JJ, Wu S, Nadler RB (2009) Robot-assisted radical prostatectomy in men aged > or = 70 years. BJU Int 104(10):1492–1495. https://doi.org/10.1111/j.1464-410X.2009.08718.xCrossRefPubMed

Labanaris AP, Witt JH, Zugor V (2012) Robotic-assisted radical prostatectomy in men >/=75 years of age. Surgical, oncological and functional outcomes. Anticancer Res 32(5):2085–2089PubMed

Rogers CG, Sammon JD, Sukumar S, Diaz M, Peabody J, Menon M (2013) Robot assisted radical prostatectomy for elderly patients with high risk prostate cancer. Urol Oncol 31(2):193–197. https://doi.org/10.1016/j.urolonc.2010.11.018CrossRefPubMed

Cusano A, Haddock P, Staff I, Jackson M, Abarzua-Cabezas F, Dorin R, Meraney A, Wagner J, Shichman S, Kesler S (2015) Surgical complications associated with robotic urologic procedures in elderly patients. Can J Urol 22(1):7607–7613PubMed

10.

Kumar A, Samavedi S, Bates AS, Giedelman Cuevas CA, Coelho RF, Rocco B, Palmer K, Patel VR (2015) Age stratified comparative analysis of perioperative, functional and oncologic outcomes in patients after robot assisted radical prostatectomy—a propensity score matched study. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 41(7):837–843. https://doi.org/10.1016/j.ejso.2015.04.006CrossRef

11.

Ubrig B, Boy A, Heiland M, Roosen A (2018) Outcome of robotic radical prostatectomy in men over 74. J Endourol 32(2):106–110. https://doi.org/10.1089/end.2017.0512CrossRefPubMedPubMedCentral

12.

Traboulsi SL, Nguyen DD, Zakaria AS, Law KW, Shahine H, Meskawi M, Negrean C, Karakiewicz PI, Hakim AE, Zorn KC (2020) Functional and perioperative outcomes in elderly men after robotic-assisted radical prostatectomy for prostate cancer. World J Urol. https://doi.org/10.1007/s00345-020-03096-0CrossRefPubMed

13.

Horovitz D, Feng C, Messing EM, Joseph JV (2017) Extraperitoneal vs transperitoneal robot-assisted radical prostatectomy in the setting of prior abdominal or pelvic surgery. J Endourol 31(4):366–373. https://doi.org/10.1089/end.2016.0706CrossRefPubMed

14.

Yaxley JW, Coughlin GD, Chambers SK, Occhipinti S, Samaratunga H, Zajdlewicz L, Dunglison N, Carter R, Williams S, Payton DJ, Perry-Keene J, Lavin MF, Gardiner RA (2016) Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet (Lond Engl) 388(10049):1057–1066. https://doi.org/10.1016/s0140-6736(16)30592-xCrossRef

15.

Nishikawa M, Watanabe H, Kurahashi T (2017) Safety and feasibility of robot-assisted radical prostatectomy for clinically localized prostate cancer in elderly Japanese patients. Prostate Int 5(1):13–16. https://doi.org/10.1016/j.prnil.2017.01.001CrossRefPubMedPubMedCentral

16.

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40(5):373–383. https://doi.org/10.1016/0021-9681(87)90171-8CrossRefPubMed

17.

Froehner M, Koch R, Litz RJ, Oehlschlaeger S, Twelker L, Hakenberg OW, Wirth MP (2008) Detailed analysis of Charlson comorbidity score as predictor of mortality after radical prostatectomy. Urology 72(6):1252–1257. https://doi.org/10.1016/j.urology.2008.05.037CrossRefPubMed

18.

Bill-Axelson A, Holmberg L, Garmo H, Taari K, Busch C, Nordling S, Haggman M, Andersson SO, Andren O, Steineck G, Adami HO, Johansson JE (2018) Radical prostatectomy or watchful waiting in prostate cancer—29-year follow-up. N Engl J Med 379(24):2319–2329. https://doi.org/10.1056/NEJMoa1807801CrossRefPubMed

19.

Wilt TJ, Jones KM, Barry MJ, Andriole GL, Culkin D, Wheeler T, Aronson WJ, Brawer MK (2017) Follow-up of prostatectomy versus observation for early prostate cancer. N Engl J Med 377(2):132–142. https://doi.org/10.1056/NEJMoa1615869CrossRefPubMed

20.

Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P, Davis M, Peters TJ, Turner EL, Martin RM, Oxley J, Robinson M, Staffurth J, Walsh E, Bollina P, Catto J, Doble A, Doherty A, Gillatt D, Kockelbergh R, Kynaston H, Paul A, Powell P, Prescott S, Rosario DJ, Rowe E, Neal DE (2016) 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 375(15):1415–1424. https://doi.org/10.1056/NEJMoa1606220CrossRefPubMed

21.

Froehner M, Koch R, Hubler M, Renner T, Borkowetz A, Zastrow S, Wirth MP (2019) Only < 10% of patients selected for radical prostatectomy reach the competing mortality rate of the prostate cancer intervention versus observation trial (PIVOT). Eur Urol Focus 5(3):361–364. https://doi.org/10.1016/j.euf.2018.01.019CrossRefPubMed

22.

Albertsen PC, Hanley JA, Penson DF, Barrows G, Fine J (2007) 13-year outcomes following treatment for clinically localized prostate cancer in a population based cohort. J Urol 177(3):932–936. https://doi.org/10.1016/j.juro.2006.10.051CrossRefPubMed

23.

Stephenson AJ, Kattan MW, Eastham JA, Bianco FJ Jr, Yossepowitch O, Vickers AJ, Klein EA, Wood DP, Scardino PT (2009) Prostate cancer-specific mortality after radical prostatectomy for patients treated in the prostate-specific antigen era. J Clin Oncol 27(26):4300–4305. https://doi.org/10.1200/jco.2008.18.2501CrossRefPubMedPubMedCentral

24.

Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB (2000) Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. J Urol 163(2):460–463CrossRef

25.

Kessler A, Sollie S, Challacombe B, Briggs K, Van Hemelrijck M (2019) The global prevalence of erectile dysfunction: a review. BJU Int. https://doi.org/10.1111/bju.14813CrossRefPubMedPubMedCentral

26.

Mendiola FP, Zorn KC, Mikhail AA, Lin S, Orvieto MA, Zagaja GP, Shalhav AL (2008) Urinary and sexual function outcomes among different age groups after robot-assisted laparoscopic prostatectomy. J Endourol 22(3):519–524. https://doi.org/10.1089/end.2006.9845CrossRefPubMed

27.

Marien T, Sankin A, Lepor H (2009) Factors predicting preservation of erectile function in men undergoing open radical retropubic prostatectomy. J Urol 181(4):1817–1822. https://doi.org/10.1016/j.juro.2008.11.105CrossRefPubMed

28.

Mandel P, Graefen M, Michl U, Huland H, Tilki D (2015) The effect of age on functional outcomes after radical prostatectomy. Urol Oncol 33(5):203.e211–208. https://doi.org/10.1016/j.urolonc.2015.01.015CrossRef

29.

Groome PA, Rohland SL, Siemens DR, Brundage MD, Heaton J, Mackillop WJ (2011) Assessing the impact of comorbid illnesses on death within 10 years in prostate cancer treatment candidates. Cancer 117(17):3943–3952. https://doi.org/10.1002/cncr.25984CrossRefPubMed

30.

Roussel B, Ouellet GM, Mohile SG, Dale W (2015) Prostate cancer in elderly men: screening, active surveillance, and definitive therapy. Clin Geriatr Med 31(4):615–629. https://doi.org/10.1016/j.cger.2015.07.004CrossRefPubMed

31.

Droz JP, Albrand G, Gillessen S, Hughes S, Mottet N, Oudard S, Payne H, Puts M, Zulian G, Balducci L, Aapro M (2017) Management of prostate cancer in elderly patients: recommendations of a Task Force of the International Society of Geriatric Oncology. Eur Urol 72(4):521–531. https://doi.org/10.1016/j.eururo.2016.12.025CrossRefPubMed

Title: Oncological and functional outcomes in patients over 70 years of age treated with robotic radical prostatectomy: a propensity-matched analysis
Authors: Pratik M. S. Gurung
Bokai Wang
Stephen Hassig
Jasmine Wood
Elizabeth Ellis
Changyong Feng
Ahmed E. Ghazi
Jean V. Joseph
Publication date: 01-04-2021
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Prostate Cancer
Prostatectomy
Prostatectomy
Published in: World Journal of Urology / Issue 4/2021
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-020-03304-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Patients and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Patients and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2021

Association between sex hormones and kidney stones: analysis of the National Health and Nutrition Examination Survey

Development and validation of an individualized DNA repair-related gene signature in localized clear cell renal cell carcinoma

Robotic-assisted kidney transplantation in obese recipients compared to non-obese recipients: the European experience

Intranasal ketamine versus intravenous morphine for pain management in patients with renal colic: a double-blind, randomized, controlled trial

Treatment decision satisfaction and regret after focal HIFU for localized prostate cancer

Complications in adulthood for patients with paediatric genitourinary reconstruction