Should radical prostatectomy be encouraged at any age? A critical non-systematic review

Elderly men are likely to be diagnosed with clinically localized prostate cancer, however only few studies have assessed the appropriate treatment in such patients. Radical prostatectomy is one valid alternative. Perioperative outcomes, functional outcomes and oncological outcomes have to be carefully discussed in patient counselling. Fewer perioperative complications, lower perioperative mortality, and shorter hospitalization times have been reported for patients undergoing radical prostatectomy by high-volume surgeons at high-volume centers. Although elderly patients are more likely to be preoperatively incontinent, and increasing age impacts negatively on continence recovery, long-term urinary continence rates have been reported to be satisfactorily high also in older patients. Potency should not be considered as a relevant outcome, since many elderly patients already suffer from longstanding erectile dysfunction and advanced age itself is associated with low chances of recovery. Although some inter-study variability exists in different oncological outcomes measured, most studies are consistent in showing no different cancer-specific survival rates between younger and older patients, thus implying that even elderly patients may benefit from radical treatment. Biological rather than chronological age should be used to base the decision as to whether a patient will profit from definitive treatment. Therefore, elderly men should undergo a health assessment using validated tools before any treatment decision. Only fit and motivated individuals with a reasonable life expectancy and, above all, high-risk disease should be offered radical prostatectomy. In these patients, high-volume surgeons and minimally invasive approaches should be preferable to minimize perioperative complications.