Robot assisted radical prostatectomy for elderly patients with high risk prostate cancer

ObjectivesThe role of robot assisted radical prostatectomy (RARP) for high-risk prostate cancer (CaP) is controversial, as is the role of RARP in elderly men. We evaluate outcomes of elderly patients with high-risk CaP who have chosen RARP over radiation or hormonal therapy.Materials and methodsBetween April 2001 and November 2009, 69 elderly patients (≥70 years) with high-risk CaP underwent RARP at our institution. High-risk CaP was defined using the D'Amico criterion, PSA ≥ 20 ng/ml, biopsy Gleason score 8–10, or clinical stage ≥ cT2C. Outcomes were retrospectively analyzed.ResultsPreoperative high-risk features were PSA > 20: 11 patients (15.9%), biopsy Gleason score 8–10: 43 (62.3%), or clinical stage ≥ cT2C: 25 (36.2%). Median OR time was 175 minutes (IQR: 136.8–202.5) and median EBL was 150 cc (IQR: 100–200). There were 4 complications (5.8%): urine leak (2) and ileus (2). Median duration of stay was 1 day and no patient had a hospital stay over 3 days. On final pathology, 26 men (37.7%) had organ-confined disease with negative surgical margins and 27 (39.1%) had extracapsular extension with negative margins. Biochemical recurrence occurred in 12 patients (17.4%) at a median follow-up of 37.7 months. There was a single incidence of positive lymph nodes at the time of surgery (1.4%). Actuarial biochemical recurrence-free survival was 91% at 12 months and 86% at 36 months. Functional outcomes assessed by patient administered questionnaire at a median follow-up of 26.2 months showed an improvement in median IPSS score from 8.0 preoperatively to 5.0 postoperatively (P = 0.0004) with 53 (81.5%) of patients using 1 pad per day or less for urine control and 7 patients (33.3%) of the 21 men with preoperative SHIM score > 21 preoperatively achieving erections sufficient for intercourse.ConclusionsRobotic RP is safe and feasible in select elderly patients with high-risk CaP with good intermediate oncologic and functional outcomes. Advanced chronological age should not be an absolute contraindication for RARP in these patients.