Laparoscopic radical prostatectomy in men older than 70 years of age with localized prostate cancer: Comparison of morbidity, reconvalescence, and short-term clinical outcomes between younger and older men

Objectives: To analyze the safety and efficacy of extraperitoneal laparoscopic radical prostatectomy (eL-RPE) in elderly versus younger men with localized prostate cancer. Methods: Patients undergoing eL-RPE were retrospectively subdivided into group eL-RPE1 (72 men aged 71 yr and older) and group eL-RPE2 (132 men aged 59 yr and younger). Group eL-RPE1 was compared with a group of 70 contemporary, comparable patients aged 71 yr and older undergoing open retropubic radical prostatectomy (group OPEN-RPE). Results: Compared with group eL-RPE2, patients of group eL-RPE1 had a higher pathologic stage (45% vs. 32% stage pT3 or greater, p < 0.001) and higher Gleason score (median 7 vs. 6, p < 0.001). Prostate- specific antigen recurrence was significantly worse compared with age-matched controls for younger patients with high-stage or high-grade lesions (p < 0.001). Importantly operative time, analgesic requirements, hospital stay, convalescence, and complication rates were comparable. Urinary continence rate was significantly better in group eL-RPE2 at 6 mo (67% vs. 91%, respectively, p < 0.001). Group eL-RPE1 and group OPEN-RPE patients had statistically similar pathologic stage and Gleason score (each p > 0.05), similar operative time (p = 0.12), but less blood loss (p < 0.001), shorter hospital stay (p < 0.001), and more rapid convalescence (p < 0.001) occurred in eL-RPE1. Conclusions: eL-RPE is feasible and efficacious even in elderly patients with unfavorable, large-volume disease. eL-RPE offers the advantages of decreased blood loss, shorter hospital stay, and more rapid recovery over OPEN-RPE. However, the elderly patient must be informed preoperatively about the observed higher incontinence rate. (c) 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved.