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October 1, 2025

Robotic‐Assisted Radical Prostatectomy in the Elderly Patient—A Study of Functional, Surgical, and Oncological Outcomes in an Australian Cohort

Puntos clave

Robotic-assisted radical prostatectomy shows no significant difference in urinary continence between elderly and younger patients.
Detailed analysis revealed that elderly patients had worse erectile function and more severe disease compared to younger counterparts.
Despite lower rates of nerve preservation in elderly patients, complication rates remained low and comparable with younger patients.
Findings underscore the safety of robotic surgery in elderly patients with prostate cancer, encouraging consideration for this treatment option.

Resumen

ABSTRACT Background Curative surgery for prostate cancer is uncommonly offered to patients aged ≥ 75, balancing functional outcomes against survival benefit. The increased adoption of robotic‐assisted radical prostatectomy (RARP) and improved overall life expectancy challenges this paradigm. The objective of this study was to compare functional outcomes between elderly and younger patients following RARP. Methods Retrospective review of a prospective multicentre database including all RARP patients between October 2016 and December 2023. Patients were divided into cohorts based on age; elderly (≥ 75 years) and younger (< 75 years). Variables included baseline demographics (body mass index BMI, American Society of Anaesthesiologists ASA classification, prostate specific antigen PSA, and Gleason score), surgical (technique, complications, and length of stay), pathological (histopathology, margins, and PSA) and functional (incontinence, International Prostate Symptom Score IPSS, International Index of Erectile Function IIEF‐5, and Expanded Prostate Index Composite EPIC) outcomes. Univariate (chi‐square and t ‐tests) and multivariate analysis were performed to compare cohorts against the primary outcome of continence at 1‐year (number of pads/day), with p ‐values < 0.05 considered statistically significant. Results A total of 397 patients were included (< 75; n = 332, ≥ 75; n = 65). No statistically significant differences were detected in continence at 1‐year in ≥ 75 (< 75; 0.73 0.59–0.87, ≥ 75; 0.66 0.37–0.95 mean pads/24 h, p = 0.8), despite significantly lower nerve preservation and bladder‐neck spare rates (< 75; 37.3%, ≥ 75; 21.5%). IIEF‐5 scores were worse in the ≥ 75 group (1.60 ± 1.17 vs. 5.73 ± 6.93 p < 0.001), however there were no significant differences in IPSS. Patient in the elderly cohort had more severe disease (67.7% T3, ≥ 75 vs. 47.3%, < 75, p < 0.05). Rates of positive surgical margins (28.3% vs. 30.8% ≥ 75) and PSA recurrence (25% vs. 23% ≥ 75) were similar. Complication rates were low in both groups with no significant differences (3% vs. 6.6% ≥ 75) and were of lower severity in the ≥ 75 group. Conclusion RARP in carefully selected elderly patients does not increase risk of urinary incontinence and should not be disregarded in an aging population with higher overall life expectancy.

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