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

Abstract

ObjectiveTo 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 methodsIn 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. ResultsOf 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. ConclusionUC 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.

Prostate Cancer in Elderly Men

“…43 Unlike reports in ORP in which older men are more likely to experience long-term postoperative incontinence, early data suggest similar rates of incontinence in older and younger men after RARP. 44 Kumar and colleagues 45 observed similar continence rates among patients aged 70 years or older (median age 72 years) and those aged 70 years or younger (median age 62 years) at 1 year after RARP (87.3% and 91.3%, P 5 .07). Similarly, incidence of biochemical recurrence at 3 and 5 years postoperatively was also observed to be similar, but differences in cancer-specific survival approached statistical significance at 5-year follow-up between patients aged 70 years or older and those aged 70 years or younger (biochemical recurrence: 81.1% and 91.1%, P 5 .83 and cancer-specific survival: 95.3% and 98.2%, P 5 .06, respectively).…”

An objective measurement of urinary continence recovery with pelvic floor physiotherapy following robotic assisted radical prostatectomy

“…A large Italian study demonstrated that early pelvic floor muscle training following RP both significantly improved time to continence recovery with 94.6% of the men who participated in pelvic floor re-training being continent at 6 months following surgery compared to 65% in the control group (8). Interestingly increasing age may delay recovery but overall results are similar (9). Finally laparoscopic versus open or robotic approach may ultimately also be similar although more data are required to demonstrate a superiority related to technique (10).…”

Survival outcomes in elderly men undergoing radical prostatectomy in Australia

“…analysed complications post‐robotic‐assisted RP between men under 69 and over 70 years in 868 men, and they found overall post‐operative complication rate for over 70 at 15.4%. In addition, 12‐month post‐operative potency and continence rates have been reported to be 75% and 69–92%, respectively . Further studies of direct comparisons between these two techniques in this cohort would be advantageous, but current evidence is encouraging for the robotic technique as a viable alternative in elderly men requiring curative surgery.…”