Effect of minimally invasive radical prostatectomy in older men

•OPRP is associated with higher risk of incontinence and erectile dysfunction compared to MIRP.•MIRP is replacing ADT and OPRP as first line treatments for prostate cancer.•Older men appear to be good surgical candidates, especially for MIRP.•MIRP is associated with good surgical outcomes, even in older men.

BackgroundMinimally invasive radical prostatectomy (MIRP) has been rapidly adopted over the last decade, however, little is known about outcomes in older patients.ObjectiveTo examine the outcomes of MIRP vs. open radical prostatectomy (OPRP) stratified by age.Subjects and methodsWe examined the Surveillance, End Results and Epidemiology-Medicare database between years 2004 and 2009 for men with nonmetastatic adenocarcinoma of the prostate. Our cohort (n = 12,092) was subdivided into 2 groups-MIRP vs. OPRP, and by patient age≥70 years (n = 6,660) vs. 66 to 69 years (n = 5,432). Multivariate analysis and multiple Cox proportional hazard models evaluated the influence of surgical approach and other variables on perioperative and postoperative complications in each age group.ResultsThe use of MIRP increased over the 6-year time span (14.8%-73.3%;<70 y) and 15.1%-69.8%;≥70 y). OPRP was associated with a higher risk of blood transfusion and postoperative respiratory or genitourinary (GU) complications. Patients who underwent MIRP were more likely to have a diagnosis of erectile dysfunction or urinary incontinence compared to OPRP (56.9% vs. 42.2% and 53.9% vs. 43.2%, respectively; P<0.0001). Patients who underwent MIRP were less likely to have an anastomotic stricture or require additional cancer therapy. Men aged≥70 years, who underwent MIRP had higher rates of transfusion, GU complications, length of stay, incontinence, and anastomotic stricture rates compared with those of men aged 66 to 69 years. However, older men undergoing MIRP had 10% lower rates of erectile dysfunction compared with that of men aged 66 to 69 years of age.ConclusionsMIRP increased to>70% of all procedures performed in 2009. MIRP is associated with lower blood transfusion rates, postoperative respiratory or GU complications, anastomotic stricture diagnoses, and additional cancer therapies. This suggests that MIRP is a successful prostate cancer treatment for older patients.