Abstract
ObjectiveAge is known to have an impact on outcomes after radical prostatectomy (RP). However, age differences can be investigated from a cross-sectional as well as from a longitudinal perspective. This study combines both perspectives.Materials and methodsLAP-01 is the first multicenter randomized patient blinded trial comparing outcomes after robotic-assisted and laparoscopic RP. This study stratified the entire population that received nerve-sparing surgery and was potent at baseline by the following ages: ≤ 60 years, 61–65 years, and > 65 years. Potency was assessed using the IIEF-5. The EORTC QLQ-C30 was used for global health perception and the EORTC QLQ-PR25 for urinary symptoms. Continence was assessed by the number of pads used. Longitudinal change was assessed using either validated anchor-based criteria or the 1 or 0.5-standard-deviation criterion. Worsening of continence was measured by increasing numbers of pads.Results310 patients were included into this study. Older patients had a significantly higher risk for worsening of continence at 3 and 6 months (OR 2.21, 95% CI [1.22, 4.02], p = 0.009 and OR 2.00, 95% CI [1.16, 3.46], p = 0.013, respectively); at 12 months, the odds of worsening did not differ significantly between age groups. Potency scores were better in younger patients from a cross-sectional perspective, but longitudinal change did not differ between the age groups. In contrast, global health perception was better in older patients from a cross-sectional perspective and longitudinal decreases were significantly more common among the youngest patients, at 12 months (36.9% vs. 24.4%, p = 0.038).ConclusionFrom a cross-sectional perspective, function scores were better in younger patients, but from a longitudinal perspective, age differences were found in continence only. In contrast, global health scores were better in older patients from a cross-sectional and longitudinal perspective.Trial registrationThe LAP-01 trial was registered with the U.S. National Library of Medicine clinical trial registry (clinicaltrials.gov), NCT number: NCT03682146, and with the German Clinical Trial registry (Deutsches Register Klinischer Studien), DRKS ID number: DRKS00007138.
Highlights
Prostate cancer is the second most common malignancy in men worldwide [1], with approximately 60,000 new cases in Germany every year [2]
In all 3 age groups, 24.4% used a safety pad without having an involuntary loss of urine. 12 months after Radical prostatectomy (RP), 69.1% of the youngest patients did not use any pads compared to 60.0% in the oldest age group
Older patients had better global health scores but worse function scores. These findings suggest that the assessment of post-RP function differs according to age
Summary
Prostate cancer is the second most common malignancy in men worldwide [1], with approximately 60,000 new cases in Germany every year [2]. Many studies have shown that long-term post-RP continence rates do not differ between age groups, while post-RP erectile dysfunction (ED) is more severe among older patients [4,5,6]. These are cross-sectional comparisons that do not consider differing baseline levels. Comparisons of longitudinal changes in quality of life (QOL) showed that severe decreases of sexual bother were more prevalent in younger patients. Such findings are important for counseling prostate cancer patients prior to RP. This study strives to validate the findings described above and reports cross-sectional and longitudinal age differences based on a prospective randomized study population
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