Comparison between robotic-assisted laparoscopic radical prostatectomy and radiotherapy with regard to oncologic control and functional outcome in elderly patients with prostate cancer

ObjectiveFrom 2006 to 2014, more than 800 patients had received robotic-assisted laparoscopic radical prostatectomy (RaLRP) at our hospital. Based on our single-center experience, the procedure has been found to be safe and feasible among these patients with regard to oncologic control and functional outcome. We compared these patients with those who received radiotherapy (RT; all aged > 75 years) and attempted to clarify whether there is any benefit with regard to oncologic control, functional outcome, and comorbidity.Materials and methodsWe performed a retrospective review of 188 prostate cancer patients aged > 75 years in our hospital over a period of 5 years (79 patients had received RaLRP and 109 patients had received RT). Cancer control result was determined based on the 1-year biochemical recurrence (BCR) rate. In the surgical group, BCR was defined as a sustained increase, on two separate occasions, in the serum total prostate-specific antigen (PSA; >0.2 ng/mL) level, whereas in the RT group it was defined as an increase in the PSA level of ≥2 ng/mL above the nadir PSA level. Functional results were determined based on the continence rate, clinical condition of low urinary tract symptoms, and other complications.ResultsRegarding oncologic control (1-year BCR rate), there was no difference between the two groups (RaLRP vs. RT: 20.93% vs. 23.95%, p = 0.6950). The 1-year continence rate in the RaLRP group was 90.69%. By contrast, 80.20% of the patients in the RT group suffered from low urinary tract symptoms requiring medication and 21.87% of the patients suffered from bladder outlet obstruction, which may require other interventions; approximately 28.12% of the patients suffered from radiation cystitis and 12.5% of patients suffered from radiation proctitis.ConclusionOur analysis shows that there is no difference in oncologic outcome between the two groups; however, there is still a lack of reliable evidence owing to the short duration of follow up. It was also difficult to confirm whether there are any benefits in functional outcomes between these two procedures. However, despite the old age of the patients, RaLRP could offer a good 1-year continence outcome.