A NOVEL prospective multicentre cohort study suggests that age alone should not be a barrier to robot-assisted radical prostatectomy (RARP) in men with localised prostate cancer, as older patients experience comparable functional recovery and perioperative safety to their younger counterparts.
Study Highlights Age-Stratified Outcomes After RARP
In the study researchers analysed outcomes in 604 patients undergoing RARP, stratified into three age groups: under 65, 65–74, and 75 years or older. Patient-reported outcomes (PROs) were assessed using the Expanded Prostate Cancer Index Composite (EPIC) at baseline and at 1, 3, 6, and 12 months after surgery.
Urinary function declined shortly after surgery across all age groups, as expected, but showed substantial recovery by 12 months. Importantly, recovery trajectories were similar regardless of age, with men aged 75 years and older achieving outcomes comparable to younger patients.
Sexual function decreased after surgery in all groups. However, younger patients maintained higher absolute function scores, particularly when nerve-sparing techniques were used. In contrast, “sexual bother”, the degree to which patients were troubled by sexual dysfunction, showed a clear age-related pattern. Older men reported minimal change in bother despite declines in function, suggesting differing expectations or adaptation with age.
Crucially, perioperative complication rates did not differ significantly between age groups, indicating that RARP can be performed safely even in older patients when appropriately selected.
Implications For Managing Prostate Cancer in an Ageing Population
The findings address a key gap in evidence as life expectancy rises and more elderly men are considered for surgical management of prostate cancer. Historically, concerns about poorer recovery and higher complication risks have limited surgical intervention in older populations.
The authors conclude that chronological age alone should not preclude patients from being offered RARP. Instead, treatment decisions should be individualised, considering overall health, functional status, and patient preferences.
This study provides important prospective data supporting the safe expansion of surgical options to older men, while highlighting the need for personalised counselling regarding functional outcomes, particularly in relation to sexual health.
Reference
Kawamura N et al. Age-stratified trajectories of patient-reported outcomes and perioperative safety after robot-assisted radical prostatectomy: a prospective multicenter cohort study. Sci Rep. 2026;doi: 10.1038/s41598-026-46171-z
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