Category: Laparoscopic/ Robotic: Prostate
Introduction & Objective :
Surgical management of prostate cancer in older patients remains controversial. As experience with robot-assisted radical prostatectomy (RARP) has increased, some centers have expanded its indication for older men. We report our experience with RARP in men age 70 and above.
Of 411 RARP performed by a single surgeon (RC) between 8/2012 and 1/2018 in Puerto Rico, 28 were performed on patients ≥70 years old. Decision for surgery was based on prostate cancer volume, severe International-Prostate Symptom Score with prostate enlargement or need of anticoagulation. Biopsy findings were stratified using the D’Amico classification. Perioperative and oncological outcomes were evaluated.
Mean age was 72.1 years (Range from 70.1 to 77.4), body mass index (BMI) was 27.7 kg/m2 (Range from 21.4 to 40.6) and preoperative prostate specific antigen (PSA) was 7.68 ng/ml (Range from 3.9 to 20). As per the D’Amico classification: 32.1% (9) patients were low risk, 42.9% (12) were intermediate risk and 25% (7) were high risk. There were no intra-operative complications or post-operative complications. Pathology showed a Gleason score <7 in 7 patients (25%) and ≥7 in 21 (75%). Tumor staging of T2 and T3 were 20 (71.4%) and 8 (28.6%) respectively. Upgrading was seen in 46.4% (13) of cases and upstaging in 57.1% (16). No positive surgical margins were identified. No evidence of lymph node metastasis was identified. At 12 months, 71.4% of patients were continent and 56% were potent. After a mean follow up of 22.9 months, prostate cancer mortality was 0% and biochemical recurrence was 7.1% (2). Those patients with biochemical recurrence were treated with externela beam radiotherapy + LHRH agonist.
RARP represents a safe and valid alternative in select patients with prostate carcinoma of age 70 years and older with excellent functional and oncological outcomes.
University of Puerto Rico
Bayamon, Not Applicable, Puerto Rico