Real chance of elderly patients achieving potency and continence after robotic RP
MedWire News: Elderly men have an acceptable probability of achieving continence and potency after robotic radical prostatectomy (RRP) for treatment of prostate cancer, according to researchers.
RRP is not traditionally offered to men above 70 years on the grounds of diminished life expectancy; however, current life expectancy for this age group in the USA is 13.7 years and increasing at a rate of 1 year per decade.
“RRP is an appealing treatment option for clinically localized prostate cancer due to fast recovery, less blood loss, improved cosmesis, and surgical outcomes comparable to open RP,” explain Sergey Shikanov, from the University of Chicago Medical Centre in Illinois, USA, and colleagues in The Journal of Urology.
They add that “rates of continence and potency after RP decrease with advancing age.”
The team calculated the probability of continence and potency a year after RRP for men aged 65, 70, or 75 years. Overall, the cohort included 1436 RRP patients aged between 38 and 85 years.
The men completed the University of California Los Angeles Prostate Cancer Index (UCLA-PCI) questionnaires to report continence (defined as being pad-free) and potency (defined as an erection sufficient for intercourse).
In all, 25% of the cohort were older than 65 years, and 5% were 70 years or older. Overall, 69% of patients were continent and 75% were potent at 1 year after surgery.
These data translate to predicted probabilities for continence of 0.66, 0.63, and 0.59, for men aged 65, 70, and 75 years, respectively. The corresponding probabilities for potency among these men were 0.66, 0.56, and 0.46.
After adjusting for potential confounders, multivariate analysis showed that age, International Prostate Symptom (I-PSS), and Sexual Health Inventory for Men (SHIM) scores – inferred from UCLA-PCI responses – were most significantly associated with a higher likelihood of continence after RRP. Similarly, age, SHIM and bilateral nerve sparing during surgery were predictors of potency after RRP.
“Multiple factors affect continence and potency after radical prostatectomy such as baseline status, surgical technique, extent of nerve-sparing, and adjuvant or salvage therapy,” write Shikanov et al.
They conclude: “In our experience there is an acceptable probability of achieving continence and potency after RRP in selected healthy elderly patients.”
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By Sarah Guy