Dataset Information

Advanced age portends poorer prognosis after radical prostatectomy: a single center experience.

ABSTRACT:

Introduction and objective

Although advanced age doesn't seem to impair oncological outcomes after robot-assisted radical prostatectomy (RARP), elderly patients have increased rates of prostate cancer (PCa) related deaths due to a higher incidence of high-risk disease. The potential unfavorable impact of advanced age on oncological outcomes following RARP remains an unsettled issue. We aimed to evaluate the oncological outcome of PCa patients > 69 years old in a single tertiary center.

Materials and methods

1143 patients with clinically localized PCa underwent RARP from January 2013 to October 2020. Analysis was performed on 901 patients with available follow-up. Patients ≥ 70 years old were considered elderly. Unfavorable pathology included ISUP grade group > 2, seminal vesicle, and pelvic lymph node invasion. Disease progression was defined as biochemical and/or local recurrence and/or distant metastases.

Results

243 cases (27%) were classified as elderly patients (median age 72 years). Median (IQR) follow-up was 40.4 (38.7-42.2) months. Disease progression occurred in 159 cases (17.6%). Elderly patients were more likely to belong to EAU high-risk class, have unfavorable pathology, and experience disease progression after surgery (HR = 5.300; 95% CI 1.844-15.237; p = 0.002) compared to the younger patients.

Conclusions

Elderly patients eligible for RARP are more likely to belong to the EAU high-risk category and to have unfavorable pathology that are independent predictors of disease progression. Advanced age adversely impacts on oncological outcomes when evaluated inside these unfavorable categories. Accordingly, elderly patients belonging to the EAU high-risk should be counseled about the increased risk of disease progression after surgery.

SUBMITTER: Porcaro AB

PROVIDER: S-EPMC9675672 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature

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Advanced age portends poorer prognosis after radical prostatectomy: a single center experience.

Porcaro Antonio Benito AB Bianchi Alberto A Gallina Sebastian S Serafin Emanuele E Mazzucato Giovanni G Vidiri Stefano S D'Aietti Damiano D Rizzetto Riccardo R Tafuri Alessandro A Cerrato Clara C Panunzio Andrea A Orlando Rossella R Brusa Davide D Brunelli Matteo M Siracusano Salvatore S Cerruto Maria Angela MA Antonelli Alessandro A

Aging clinical and experimental research 20220817 11

<h4>Introduction and objective</h4>Although advanced age doesn't seem to impair oncological outcomes after robot-assisted radical prostatectomy (RARP), elderly patients have increased rates of prostate cancer (PCa) related deaths due to a higher incidence of high-risk disease. The potential unfavorable impact of advanced age on oncological outcomes following RARP remains an unsettled issue. We aimed to evaluate the oncological outcome of PCa patients > 69 years old in a single tertiary center.<h ...[more]

PMID: 35976572

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Project description:Background and objectiveThe role of pelvic lymph node dissection (PLND) for prostate cancer is still controversial. This study aims to compare the outcomes of PLND between extraperitoneal single-port (SP eRARP) and transperitoneal multiport (MP tRARP) robotic-assisted radical prostatectomy.MethodsThis was a retrospective analysis from our single-center database for patients who underwent SP eRARP or MP tRARP with PLND between 2015 and 2023. The primary endpoint was to analyze and compare specific data related to PLND between the two populations by the detection of pN+ patients, the total number of lymph nodes removed, and the number of positive lymph nodes removed. The secondary endpoints included comparing major complications, lymphoceles, and biochemical recurrence between the two cohorts of the study.Key findings and limitationsA total of 293 patients were included, with 85 (29%) undergoing SP eRARP and 208 (71%) undergoing MP tRARP. SP eRARP showed significant differences in PLND extension from MP tRARP, while MP tRARP yielded more lymph nodes (p < 0.001). There were no differences in pN+ patient detection (p = 0.7) or the number of positive lymph nodes retrieved (p = 0.6). The rates of major complications (p = 0.6), lymphoceles (p = 0.2), and biochemical recurrence (p = 0.9) were similar between the two groups. Additionally, SP eRARP had shorter operative time (p = 0.045), hospital stay (p < 0.001), and less postoperative pain at discharge (p = 0.03). Limitations include a retrospective, single-center analysis.Conclusions and clinical implicationsDespite the SP approach in RARP resulting in fewer retrieved lymph nodes, outcomes were comparable with the MP approach regarding the detection of patients with positive lymph nodes and the number of positive nodes. Additionally, the SP approach led to lower pain levels and shorter hospital stays.Patient summaryWith this study, we demonstrate that pelvic lymph node dissection performed via the extraperitoneal approach during robotic-assisted radical prostatectomy with a single-port system provides comparable outcomes with the standard transperitoneal multiport approach in detecting patients with positive lymph nodes and retrieving positive nodes. In addition, it offers significantly reduced pain levels and shorter hospital stays.

Project description:BackgroundRadical prostatectomy is the standard of care in patients with prostate cancer. Robot-assisted prostatectomy have been used as alternatives to open surgery as they result in less bleeding and allow patients to return to normal activities sooner. This study sought to evaluate the medical factors and health economics of robot-assisted and laparoscopic-assisted prostate cancer surgery to provide a valuable reference for clinicians, patients, and their families when selecting a surgical method for prostate cancer.MethodsPatients treated with Da Vinci robot-assisted surgery (DVRS) or laparoscopic-assisted surgery (LS) between January 1, 2019, and June 1, 2021, were included in this retrospective analysis. The general baseline data included age, height, weight, body mass index (BMI), preoperative total prostate specific antigen (TPSA), Gleason score, tumor stage, operation time, intraoperative blood loss volume, hospital stay, drainage volume within 24 hours postoperatively, extubation time, postoperative hospital stay, and detailed hospitalization expenditure. The medical and health economics factors were compared between the two prostatectomy techniques.ResultsThe preoperative characteristics of the patients in the DVRS group and LS group were comparable, and the differences were not statistically significant (all P>0.05). Compared to the LS group, the operation time was significantly longer in the DVRS group, whereas the volume of intraoperative blood loss, hospital stay, extubation time, and postoperative hospital stay were all markedly lower (all P<0.05). Also, the treatment, nursing, and total operation costs were considerably lower in the DVRS group compared to the LS group, while the medical material cost, total hospitalization cost, and personal expenses were all notably higher (all P<0.05).ConclusionsDa Vinci robot-assisted prostatectomy is safe; however, the health economics should not be neglected that the robot-assisted operation cannot completely replace the conventional laparoscopic operation in the short term. The consideration of both clinical efficacy and health economics is necessary to provide suggestions for the choice of modus operandi.

Dataset Information

Advanced age portends poorer prognosis after radical prostatectomy: a single center experience.

Introduction and objective

Materials and methods

Results

Conclusions

Publications

Advanced age portends poorer prognosis after radical prostatectomy: a single center experience.

Similar Datasets

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