Back to Program


PATIENTS ≥ 70 YEARS MAY BE OFFERED ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY AS A TREATMENT OPTION FOR LOCALIZED PROSTATE CANCER: A MULTI-INSTITUTIONAL EXPERIENCE
Sammy Elsamra, M.D.1, George Haleblian, M.D,1, Ihor Sawczuk, M.D.2, Ravi Munver, M.D.2, Jennifer K. Yates, MD2, Joseph Renzulli, III, M.D.1, Gyan Pareek, M.D.1.
1Brown University, Warren Alpert School of Medicine, Providence, RI, USA, 2Hackensack University Medical Center, Hackensack, NJ, USA.

BACKGROUND:
The application of minimally-invasive radical prostatectomy has expanded over the last decade with the introduction of the robotic platform. Recently, there has been increasing concern and controversy with regard to prostate cancer screening guidelines, especially in the elderly patient population. In patients with a reasonable life expectancy, appropriate treatment for prostate cancer may be advised, as compared to expectant management. We evaluated the feasibility of offering robot-assisted laparoscopic prostatectomy (RALP) to patients 70 years of age and older.
METHODS:
Patients 70 years undergoing RALP at two institutions between 2005 and 2009 were retrospectively reviewed. Preoperative variables, operative parameters, and postoperative outcomes were assessed.
RESULTS:
A total of 52 patients met the study criteria with a mean age of 71.0 years (range 69.5 to 75) and mean body mass index (BMI) of 27 kg/m2. Mean preoperative PSA was 6.2 ng/dL and mean biopsy Gleason score was 6.5 (range 6 to 8). Total operative time averaged 204 minutes and mean estimated blood loss was 130 mL. Mean hospital stay was 1.6 days. Mean pathologic Gleason score was 6.8 (range 6 to 8), and mean prostate weight was 57.2 grams (range 23-135). Pathologic staging data is shown in Table I and is compared to the cohort of patients ≤ 69 years old (n=647). Three (6%) perioperative complications occurred. One patient underwent immediate open exploration and anastomosis reconstruction due to poor urinary drainage via the urethral catheter. Another patient developed lower extremity deep venous thrombosis and was started on anticoagulation. A third patient was readmitted on the fifth postoperative day for gross hematuria and was managed conservatively.
CONCLUSIONS:
Robot-assisted laparoscopic radical prostatectomy is safe in patients aged 70 years or older. In our experience a significant number of patients had disease with higher risk features based on pathologic evaluation. The oncologic benefits of RALP may outweigh the low complication rate in appropriately selected elderly patients with clinically localized prostate cancer.

Pathologic data of septuagenarians and younger cohort.
pT2apT2bpT2cpT3apT3bpT4
Age < 70 years16.8%1.4%66.8%10.3%4.5%0.2%
Age >/ 70 years18%0%63%17%2%0%


Back to Program