Effect of Age on Robotic-Assisted Radical Prostatectomy Outcomes: A Multi-center Analysis

To evaluate the association between age and risk of perioperative complications and whether age-related increases in complication risk are of clinical significance in the era of robotic-assisted radical prostatectomies.

We pooled prostatectomy outcomes during 2012-2022 from Cornell (n = 585), Georgetown (n = 319), and Memorial Sloan Kettering (n = 6419) to assess the primary outcome of any major complication (Clavien-Dindo grade ≥3) within 30 days of surgery. We used multivariable regression to determine the relationship between age and complications, adjusting for surgeon volume and oncologic risk (prostate specific antigen, surgery grade group, extracapsular extension, seminal vesical invasion, lymph node involvement, and surgical margin status).

Major complications were similar at 2.2%, 4.1%, and 2.1% for Cornell, Georgetown, and Memorial Sloan Kettering, respectively. Older age was associated with an increased risk of complications (OR 1.03 per year, 95% CI 1.00-1.05, P = .022). However, the absolute increase in risk was small; the estimated risk of major complication for a 60-, 70- and 80-year-old was 2.0% (95% CI 1.7-2.4), 2.6% (95% CI 2.1-3.2) and 3.3% (95% CI 2.2-4.9), respectively. Limitations include observational biases associated with the retrospective study design.

Our study is the first to demonstrate that although older age is associated with an increased risk of complications, the absolute increase in risk is low and excludes a clinically relevant increase in risk in older men. Therefore, the risk of complications alone should not drive treatment choice in well-selected older prostate cancer patients.