Advanced Age Need Not Rule Out RALP

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SHANGHAI—Advanced age may not be a contraindication to robot-assisted laparoscopic prostatectomy (RALP) for localized prostate cancer, researchers reported at the 2008 World Congress of Endourology meeting here.

Investigators studied 154 men who underwent RALP for localized tumors. Of these, 19 were aged 70 years and older and 135 were younger than 70.

The researchers observed no significant differences in postoperative American Urological Association Symptom Scores; rates of incontinence and bladder-neck contractures; and proportion of subjects needing less than one incontinence pad per day at one, three, and six months after surgery. The two groups also had a similar average time to full recovery and return to usual activities (five to six weeks).

The older group, however, had a significantly longer average hospital stay than the younger group (2.8 vs. 1.8 days) and greater use of precautionary incontinence pads six months after surgery. In addition, the duration of oral narcotic use was longer in the older group. Significantly more of the older men had a pathologic prostatectomy Gleason grade of 7 or higher (68.4% vs. 40.7%).

“Many urologists would not be screening men for prostate cancer at this age, but with such low morbidity after laparoscopic surgery, there are few reasons not to perform an oncologic procedure if the patient and urologist believe this is the patient's best option,” noted co-investigator Joshua J. Meeks, MD, PhD, a urology resident at the Feinberg School of Medicine, Northwestern University, Chicago.

Commenting on the new findings, Kevin C. Zorn, MD, assistant professor of surgery and urology at the University of Chicago, agreed that the study showed that RALP is feasible to perform in older patients. Dr. Zorn, who is co-director of the university's minimally invasive urology fellowship, observed that “[the procedure] is probably most feasible in patients with lower Gleason scores and a low prostate-specific antigen level who you think still have organ-confined disease.”

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