Category: Laparoscopic/ Robotic: Prostate

MP15-6 - Robot-Assisted Radical Prostatectomy in Hispanic Men of Age 70 Years and Older.

Sat, Sep 22
10:00 AM - 12:00 PM

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.

Methods :

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.

Results :
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.

Conclusions :

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. 

Braulio Cuesta-Camunas

Medical student
University of Puerto Rico
Bayamon, Not Applicable, Puerto Rico

Ronald G. Cadillo-Chavez

Assistant professor
University of Puerto Rico
Guaynabo, Not Applicable, Puerto Rico

Ronald Cadillo-Chavez MD
Assistant Profesor University of Puerto Rico
Robotic Urology & Oncology Institute
Robotic Urologic Oncology and Reconstructive Surgery.