Целесообразность и риски применения нервосберегающей техники радикальной простатэктомии в отношении пациентов старшей возрастной группы

Abstract

OBJECTIVE To evaluate the efficacy and safety of radical prostatectomy (RP) with nerve-saving technique (NST) in patients more or equal 65 years of age compared with a younger group of patients. MATERIALS AND METHODS The study group comprised 117 patients more or equal 65 years old, the control group - 333 patients <65 years old, who underwent RP with unilateral or bilateral NST from January 2012 to December 2019. The analysis of pathomorphological results, complications rate, recurrence free survival (RFS) and the restoration of erectile function (EF) in both groups was performed. RESULTS The majority of older patients belonged to intermediate and high risk groups of biochemical recurrence. Extracapsular tumor extension was significantly more often observed in the group more or equal 65 years of age: 16.2% and 6.9%, p=0.028. There were no differences between the two groups in the frequency of serious postoperative complications ( more or equal III class according to the Clavien-Dindo classification): 2.55% and 2.7%; p=0.94. The five-year RFS after RP was 95.4% in the group <65 years old and 92.1% in the group more or equal 65 years old (p=0.31). There was a moderate tendency to a slower recovery of EF in older patients: sufficient EF after 6 and 12 months was observed in 21.9% and 59.4% versus 33.3% and 73% in the group <65 years old (p=0.12). Minimal differences in EF were observed 24 months after RP with bilateral NST (84.2% and 87.9%), and more relevant differences with unilateral NST: 53.8% and 66.7% in the study and control group (p=0.033). CONCLUSIONS The performance of RP with NST in elderly patients is not associated with additional oncological risks, while the restoration of EF is somewhat slowed down in comparison with a group of patients <65 years of age. Bilateral NST provides high potency recovery results regardless of age.