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Blezien O, Bentellis I, Tibi B, Shaikh A, Rambaud C, Boulahssass R, De Cobelli O, Chevallier D, Ahallal Y, Durand M. Robot assisted radical prostatectomy in fit older patients compared to a standard population: Clinical characteristics, surgical, oncological and functional outcomes. Prog Urol 2023; 33:272-278. [PMID: 36764858 DOI: 10.1016/j.purol.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/04/2023] [Accepted: 01/16/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION To compare robotic assisted radical prostatectomy (RARP) in well-selected older patients with clinically localized prostate cancer, compared to a younger population. Primary endpoint was perioperative outcomes comparison and secondary endpoint were oncological and functional outcomes comparison to a younger population. METHODS Single tertiary center cohort of consecutive patients treated with RARP (2017-2020) with retrospective analysis. Patients were classified by age in two groups: <75: control group (CG) and ≥75: study group (SG). Patients aged ≥75 had a comprehensive geriatric assessment (CGA) and only patients classified Balducci ≤2 were admitted to surgery. RESULTS Two hundred and sixty-nine patients were included, 56 in SG and 213 in CG. Median follow-up was 9.8 months. Univariate analysis showed no statistically significant (SS) difference between the groups for patients' characteristics (PSA, digital rectal examination -DRE- and biopsy Gleason Score), perioperative data (operative time, hospitalization length, transfusions rate, immediate complications, Clavien-Dindo complications, 30-days re-interventions and 30-days re-hospitalisation), oncological (TNM, margins, extraprostatic extension, postoperative PSA, BCR, metastases, overall survival -OS- and cancer specific survival -CSS-) and functional outcomes. Median perioperative blood loss was lower in the SG: 200.00 cc IQR [100.00, 300.00] vs 200.00cc IQR [100.00, 400.00] in the CG (P<0.05). A multivariate regression considering age>75, DRE, GS, PSA, cardiovascular history and diabetes showed none of variables associated with early BCR. Limitations are retrospective design, small number of patients and short follow-up. CONCLUSIONS RARP shows similar perioperative, oncologic and functional outcomes for older patients selected by a CGA when compared to younger patients. The SG shows a minor perioperative bleeding. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- O Blezien
- Università degli Studi di Milano, Urology Department - Istituto Europeo di Oncologia, Milano, Italy; Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU Nice, France.
| | - I Bentellis
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU Nice, France
| | - B Tibi
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU Nice, France
| | - A Shaikh
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU Nice, France
| | - C Rambaud
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est, CHU de Nice, France
| | - R Boulahssass
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est, CHU de Nice, France; FHU Oncoage, Nice, France
| | - O De Cobelli
- Università degli Studi di Milano, Urology Department - Istituto Europeo di Oncologia, Milano, Italy
| | - D Chevallier
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU Nice, France
| | - Y Ahallal
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU Nice, France
| | - M Durand
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU Nice, France; INSERM U108, CNRS UMR 7284, Nice University Côte d'Azur, France
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Mitsuzuka K, Koie T, Narita S, Kaiho Y, Yoneyama T, Tsuchiya N, Kakoi N, Kawamura S, Tochigi T, Ohyama C, Habuchi T, Arai Y. Are pathological and oncological outcomes of elderly men treated with radical prostatectomy worse than those of younger men? Matched-pair analysis between patients aged <70 and ≥70 years. Jpn J Clin Oncol 2014; 44:587-92. [PMID: 24721676 DOI: 10.1093/jjco/hyu038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To compare oncological outcomes of patients aged ≥70 years treated with radical prostatectomy with those of a clinically matched younger cohort. METHODS Data from 1268 patients undergoing radical prostatectomy between 2000 and 2009 were retrospectively reviewed. Patients were classified according to age (<70 or ≥70 years) at the time of prostatectomy. After matching pre-operative factors (i.e. prostate specific antigen, positive biopsy cores, Gleason score, clinical stage and D'Amico risk group), 333 patients were chosen from each group. RESULTS The percentage of pathological stage ≥T3 in those of age <70 and ≥70 years was 30.3 and 33.0%, respectively (P = 0.51). The percentage of pathological Gleason score ≤6, 7 and ≥8 was not significantly different between the two age groups (P = 0.08). The percentage of organ-confined disease in those of age <70 and ≥70 years was 69.4 and 67.0%, respectively (P = 0.56). With a median follow-up of 50 months, 5-year prostate specific antigen recurrence-free survival in those of age <70 and ≥70 years was 83.4 and 80.1%, respectively (log rank, P = 0.199). Five-year cancer-specific survival in those of age <70 and ≥70 years was 100 and 99.4%, respectively (log rank, P = 0.317). Five-year overall survival in those of age <70 and ≥70 years was 98.4 and 96.4%, respectively (log rank, P = 0.228). CONCLUSIONS Pathological and oncological outcomes in elderly patients (age ≥70 years) treated with radical prostatectomy were not significantly different from those of younger patients (age <70 years). This information will help refine the indications for definitive treatment for localized prostate cancer in elderly men.
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Affiliation(s)
- Koji Mitsuzuka
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai Michinoku Japan Urological Cancer Study Group
| | - Takuya Koie
- Michinoku Japan Urological Cancer Study Group Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki
| | - Shintaro Narita
- Michinoku Japan Urological Cancer Study Group Department of Urology, Akita University Graduate School of Medicine, Akita
| | - Yasuhiro Kaiho
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai Michinoku Japan Urological Cancer Study Group
| | - Takahiro Yoneyama
- Michinoku Japan Urological Cancer Study Group Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki
| | - Norihiko Tsuchiya
- Michinoku Japan Urological Cancer Study Group Department of Urology, Akita University Graduate School of Medicine, Akita
| | - Narihiko Kakoi
- Michinoku Japan Urological Cancer Study Group Department of Urology, Miyagi Cancer Center, Natori, Japan
| | - Sadafumi Kawamura
- Michinoku Japan Urological Cancer Study Group Department of Urology, Miyagi Cancer Center, Natori, Japan
| | - Tatsuo Tochigi
- Michinoku Japan Urological Cancer Study Group Department of Urology, Miyagi Cancer Center, Natori, Japan
| | - Chikara Ohyama
- Michinoku Japan Urological Cancer Study Group Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki
| | - Tomonori Habuchi
- Michinoku Japan Urological Cancer Study Group Department of Urology, Akita University Graduate School of Medicine, Akita
| | - Yoichi Arai
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai Michinoku Japan Urological Cancer Study Group
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