Robotic-assisted radical prostatectomy in patients 80+ years: a multi-centre experience

Prostate cancer (PCa) is a major health concern in ageing populations. While guidelines often preclude older men from robotic-assisted radical prostatectomy (RARP), outcomes are not well defined. We evaluated functional and oncological outcomes of RARP in patients ≥ 80 years. A multi-centre review of prospectively maintained surgical databases from three high-volume robotic surgeons was performed. Men ≥ 80 years old who underwent RARP between 2016 and 2024 were included. Demographic, surgical, functional, and oncological outcomes were analysed. Thirty men (mean age 82.6 years) were included. Fifteen, five and ten patients had ISUP Grade Group 2-3, 4 and 5 diseases, respectively. Twenty (20/30, 67%) patients had high-risk disease, with 16 clinical stage ≥ T2c. Mean operative time was 132 min and mean estimated blood loss was 187 mLs. Two complications occurred, one Clavien-Dindo grade II and one grade III. Median follow-up was 30.5 months (IQR 11.5-45.3). At 12 months, 16 out of 23 patients (70%) were pad-free or using one safety pad, and 4 (4/23, 17%) required one pad/day. Pathology revealed locally advanced disease in 22 (22/30, 73%) patients (≥ T3), and 6 (6/22, 20%) patients with a positive surgical margin. Biochemical recurrence is defined as PSA ≥ 0.2 ng/ml (Bellera et al. Ann Oncol 23(8):2166-2172, 2012) and it was observed in 11 patients (11/30, 37%), with 7 patients receiving further treatment. Small cohort size and retrospective analysis limit generalisability. RARP is safe and feasible in carefully selected octogenarians, showing acceptable functional and oncological outcomes. Older men should not be precluded from surgery based on age alone. This study supports offering RARP to these men after counselling on peri-operative risks and alternatives.