PERIOPERATIVE AND ONCOLOGICAL OUTCOMES IN HIGH RISK ELDERLY PATIENTS

Aim of the study ontroversy continues to exist concerning the treatment of choice for D’Amico high risk elderly patients. The purpose of this study is to compare the perioperative and oncologic outcomes of robotic assisted radical prostatectomy (RARP) in D’Amico high risk, propensity score-matched elderly and younger cohorts. Materials and methods From January 2008 through August 2012, 3818 patients underwent RARP at our institution by a single surgeon (VP). Retrospective analysis of prospectively collected data from our Institutional Review Board approved registry identified 80 D’Amico high risk patients, 70 years of age and over. A propensity scorematch analysis was conducted using multivariable analysis to compare elderly patients (age 70 and over) to those under 70. The final two study cohorts – D’Amico high risk elderly patients (n=80) and D’Amico high risk younger patients (n=80) constituted the clinical material for this comparative study of perioperative and oncologic outcomes. Results Preoperative clinical characteristics were similar for the two matched groups. The operative time, transfusion rate and intra-operative complications were similar for the two groups.The mean estimated blood loss was significantly greater in younger patients (156.1 ± 84.2 mLvs 113.6 ± 67.7; p=0.002). No significant differences were observed in laterality, ease of nerve sparing or surgeon subjectively assessed anastomosis and pathological outcomes between the groups. No significant differences were found in postoperative complication rates, overall pain scores, length of stay or duration of indwelling catheterization. At follow-up, freedom from biochemical recurrence (BCR) in elderly patients was 85.0% vs. 83.8% in younger patients. The mean time to BCR in elderly patients was 15.0 months (range, 2.3 to 38.8) and 14.5 months (range, 5.2 to 35.1) in younger patients. Discussion Conclusions This study clearly demonstrates that RARP can be performed in D’Amico high risk elderly patients without increasing perioperative morbidity and with oncologic outcomes comparable to high risk younger patients. RARP in elderly patients presenting with localized prostate cancer should be considered a viable treatment alternative based on the individual’s life expectancy.