MP60-18\u2003ROBOT-ASSISTED RADICAL PROSTATECTOMY IN THE ELDERLY: A PROPENSITY-MATCHED COMPARISON OF ONCOLOGICAL AND FUNCTIONAL OUTCOMES

Abstract

INTRODUCTION AND OBJECTIVES: Radical prostatectomy is the recommended definitive surgical treatment for organ-confined prostate cancer in eligible men who meet the criteria for curative radical therapy. One of the main eligibility criteria is that the life expectancy should be at least 10 years. Compared to open surgery, whilst the reduction in the morbidity of surgery through robot-assisted radical prostatectomy (RARP) would intuitively suggest its potential advantage in the elderly, data specifically addressing its outcomes in the elderly are sparse. The aim of this study was to report on the safety (complications) and efficacy (oncological and functional outcomes) of RARP at our institution in those aged over 70. 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 was performed, incorporating multiple covariates (e.g. Charlson Comorbidity Index, ASA, BMI, PSA, D Amico risk, etc.), to stratify the comparison groups of patients into Age <70 and Age≥71. RESULTS: Apart from Age (Mean ± SD years: 73.5 ± 2.1 versus 59.5 ± 5.9, p<0.001), the two groups were matched (all p-values >0.05) except for D Amico grading which was higher in the Age ≥71 group. Median follow-up was 4.9 years. There were no 90-day mortalities in either group. Major [Clavien ≥Grade 3] and minor [Clavien <3] complications (p=0.08), Operating time (p=0.79), Estimated Blood Loss (p=0.29), Length of hospital stay (p=0.09) and catheterization duration (p=0.12) were similar. On final pathology, a higher Gleason score (p=0.006) and higher stage (p<0.001) were observed in the Age≥71 group. However, this did not translate adversely into a higher positive surgical margin, positive lymph node, biochemical relapse or cancer-specific mortality (p>0.05), allowing for the current follow-up duration (median 4.9 years). In terms of functional outcomes, there were no differences in post-operative erectile dysfunction (p=0.42). However, pad-free continence was significantly better in the younger cohort (p<0.001). CONCLUSIONS: RARP should not be denied to those over 70 years solely on the basis of their age. Older men need to be counseled about the likelihood of encountering a higher rate of higher risk features on final pathology and that their pad-free continence may be lower compared to a younger person. Source of Funding: None