Early urinary continence recovery after robot-assisted radical prostatectomy in older Australian men

Abstract

Objective: To compare the recovery of urinary continence (UC) after robot-assisted radical prostatectomy (RARP) in men aged ≥70 and <70 years at 1-year follow-up and to assess for preoperative predictors of UC recovery, as older, healthy men with localised prostate cancer are often denied curative surgical treatment on the grounds of worse UC recovery.

Patients and methods: In all, 262 patients with prostate cancer having undergone RARP between May 2008 and September 2012, under the care of two consultant urological surgeons at three Melbourne hospitals, were identified. Patients were categorised based on their age ≥70 and <70 years and compared with regards to two endpoints; percentage fully continent and mean pads/day at 4-6 weeks, and 3, 6, 9 and 12 months after RARP.

Results: Of the 262 men, 9% (24) were aged ≥70 years. Older men had higher PSA levels (P = 0.007) and clinical stages (P < 0.001) compared with the younger cohort. There were more non-nerve sparing procedures in the older group (P = 0.009) and a shorter mean operative time (P = 0.004). At 4-6 weeks after RARP, the number of pads used per day was greater in older men (P = 0.03) and there was a trend towards fewer older men being fully continent (P = 0.08) than their younger counterparts; however, by 3 months and all time-points thereafter there was no difference. The 12-month UC rates were 89% and 92% for men aged <70 and ≥70 years, respectively. Neither age, body mass index, D'Amico risk group, nerve sparing nor use of Rocco suture were predictors of time to UC recovery.

Conclusion: UC recovery after RARP in men aged ≥70 years appears comparable to younger men and therefore not a reason to deny older men with a reasonable life-expectancy curative surgical treatment of localised prostate cancer.

Keywords: older men; prostate cancer; radical prostatectomy; robot-assisted; urinary continence.