Does age affect functional and perioperative outcomes after robotic-assisted prostatectomy in localized prostate cancer?

Abstract

Robotic-assisted laparoscopic prostatectomy (RALP) is widely accepted for treating localized prostate cancer, particularly in low- and intermediate-risk groups. However, the impact of advancing age on postoperative continence recovery and complication rates remains uncertain, often influencing treatment decisions in elderly patients. To evaluate the influence of age on continence outcomes and perioperative complications following RALP in patients with low- and intermediate-risk prostate cancer. This retrospective study included 439 patients undergoing RALP, stratified into three age groups: ≤ 60 years (n = 133), 61-70 years (n = 221), and > 70 years (n = 85). Baseline demographic, perioperative, pathological, continence recovery, and biochemical recurrence outcomes were compared across groups. Continence was assessed at 3, 6, 12, and 24 months postoperatively. Complication rates were classified using the Clavien-Dindo system. Higher comorbidity scores (≥ 3) were more frequent in patients over 70 years (25.9% vs. 9% in ≤ 60 years, p = 0.022). Mean preoperative PSA was significantly higher in the oldest group (7.67 vs. 6.54 ng/mL, p = 0.039). Operative time and estimated blood loss were similar across groups (p = 0.138 and p = 0.677). Length of stay showed a trend toward longer hospitalization in older patients (≥ 3 days: 21.2% in > 70 vs. 7.5% in ≤ 60 years, p = 0.058). Pathological staging and Gleason grades were comparable (p > 0.3). Continence recovery at 3 months was similar (70.6-72.2%, p = 0.27), with slightly lower rates at 1 year in patients > 70 years (77.6% vs. 88.0% in ≤ 60). Biochemical recurrence rates and adjuvant therapy usage did not differ significantly (p > 0.6). Only 3 major complications exceeding Clavien-Dindo grade 2 were reported (p > 0.8). RALP is safe and effective across age groups, including elderly patients, with comparable oncologic and functional outcomes. Age alone should not preclude consideration of RALP in appropriately selected patients. These findings support individualized counseling and treatment planning to optimize outcomes in older adults.