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Updated: Mar 26, 2026
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Effect of minimally invasive radical prostatectomy in older men
Oluwakayode Adejoro1, Priyanka Gupta2, Matthew Ziegelmann3
1Department of Urology, University of Minnesota, Minneapolis, MN.
Background:
Minimally invasive radical prostatectomy (MIRP) has been rapidly adopted over the last decade, however, little is known about outcomes in older patients.
Objective:
To examine the outcomes of MIRP vs. open radical prostatectomy (OPRP) stratified by age.
Subjects And Methods:
We examined the Surveillance, End Results and Epidemiology-Medicare database between years 2004 and 2009 for men with nonmetastatic adenocarcinoma of the prostate. Our cohort (n = 12,092) was subdivided into 2 groups-MIRP vs. OPRP, and by patient age≥70 years (n = 6,660) vs. 66 to 69 years (n = 5,432). Multivariate analysis and multiple Cox proportional hazard models evaluated the influence of surgical approach and other variables on perioperative and postoperative complications in each age group.
Results:
The use of MIRP increased over the 6-year time span (14.8%-73.3%;<70y) and 15.1%-69.8%;≥70y). OPRP was associated with a higher risk of blood transfusion and postoperative respiratory or genitourinary (GU) complications. Patients who underwent MIRP were more likely to have a diagnosis of erectile dysfunction or urinary incontinence compared to OPRP (56.9% vs. 42.2% and 53.9% vs. 43.2%, respectively; P<0.0001). Patients who underwent MIRP were less likely to have an anastomotic stricture or require additional cancer therapy. Men aged≥70 years, who underwent MIRP had higher rates of transfusion, GU complications, length of stay, incontinence, and anastomotic stricture rates compared with those of men aged 66 to 69 years. However, older men undergoing MIRP had 10% lower rates of erectile dysfunction compared with that of men aged 66 to 69 years of age.
Conclusions:
MIRP increased to>70% of all procedures performed in 2009. MIRP is associated with lower blood transfusion rates, postoperative respiratory or GU complications, anastomotic stricture diagnoses, and additional cancer therapies. This suggests that MIRP is a successful prostate cancer treatment for older patients.
Insights
Minimally invasive radical prostatectomy (MIRP) is a successful prostate cancer treatment for older patients, showing lower complication rates. While older men (≥70) undergoing MIRP had more transfusions and incontinence, they experienced less erectile dysfunction.
Area of Science:
- Urology
- Oncology
- Surgical Outcomes
Background:
- Minimally invasive radical prostatectomy (MIRP) adoption has increased, but outcomes in elderly patients remain understudied.
- Prostate cancer treatment decisions require careful consideration of surgical approach and patient age.
Purpose of the Study:
- To compare outcomes of MIRP versus open radical prostatectomy (OPRP).
- To stratify surgical outcomes by patient age, specifically comparing those ≥70 years to those 66-69 years.
Main Methods:
- Analysis of the Surveillance, End Results and Epidemiology-Medicare database (2004-2009).
- Cohort of 12,092 men with nonmetastatic prostate cancer, divided into MIRP and OPRP groups.
- Subgroup analysis by age (≥70 vs. 66-69 years) using multivariate and Cox proportional hazard models.
Main Results:
- MIRP utilization rose significantly, exceeding 70% by 2009 for both age groups.
- OPRP was linked to higher risks of blood transfusion and respiratory/genitourinary (GU) complications.
- MIRP patients had higher rates of erectile dysfunction and incontinence but fewer anastomotic strictures and less need for additional cancer therapy.
Conclusions:
- MIRP demonstrates favorable outcomes, including reduced complications and need for further treatment, making it a viable option for older prostate cancer patients.
- While older patients (≥70) undergoing MIRP showed increased rates of transfusion, GU complications, and incontinence, they also experienced lower rates of erectile dysfunction compared to younger counterparts.
