title: Effect of minimally invasive radical prostatectomy in older men.
abstract: BACKGROUND
  Minimally invasive radical prostatectomy (MIRP) has been rapidly adopted over the last decade, however, little is known about outcomes in older patients.
  
  
  OBJECTIVE
  To examine the outcomes of MIRP vs. open radical prostatectomy (OPRP) stratified by age.
  
  
  METHODS
  We examined the Surveillance, End Results and Epidemiology-Medicare database between years 2004 and 2009 for men with nonmetastatic adenocarcinoma of the prostate. Our cohort (n = 12,092) was subdivided into 2 groups-MIRP vs. OPRP, and by patient age≥70 years (n = 6,660) vs. 66 to 69 years (n = 5,432). Multivariate analysis and multiple Cox proportional hazard models evaluated the influence of surgical approach and other variables on perioperative and postoperative complications in each age group.
  
  
  RESULTS
  The use of MIRP increased over the 6-year time span (14.8%-73.3%;<70y) and 15.1%-69.8%;≥70y). OPRP was associated with a higher risk of blood transfusion and postoperative respiratory or genitourinary (GU) complications. Patients who underwent MIRP were more likely to have a diagnosis of erectile dysfunction or urinary incontinence compared to OPRP (56.9% vs. 42.2% and 53.9% vs. 43.2%, respectively; P<0.0001). Patients who underwent MIRP were less likely to have an anastomotic stricture or require additional cancer therapy. Men aged≥70 years, who underwent MIRP had higher rates of transfusion, GU complications, length of stay, incontinence, and anastomotic stricture rates compared with those of men aged 66 to 69 years. However, older men undergoing MIRP had 10% lower rates of erectile dysfunction compared with that of men aged 66 to 69 years of age.
  
  
  CONCLUSIONS
  MIRP increased to>70% of all procedures performed in 2009. MIRP is associated with lower blood transfusion rates, postoperative respiratory or GU complications, anastomotic stricture diagnoses, and additional cancer therapies. This suggests that MIRP is a successful prostate cancer treatment for older patients.
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, MN.
authors.forename: Oluwakayode
authors.initials: O
authors.lastname: Adejoro
authors.affiliation: Department of Urology, Beaumont Health System, Royal Oak, MI.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Gupta
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Matthew
authors.initials: M
authors.lastname: Ziegelmann
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, MN.
authors.forename: Christopher
authors.initials: C
authors.lastname: Weight
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, MN. Electronic address: brkonety@umn.edu.
authors.forename: Badrinath
authors.initials: B
authors.lastname: Konety
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D007172:Erectile Dysfunction / Q000209:etiology; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology; D016016:Proportional Hazards Models; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012307:Risk Factors; D018426:SEER Program / Q000706:statistics & numerical data; D014549:Urinary Incontinence / Q000209:etiology
keywords: Elderly; Minimally invasive surgery; Outcomes; Prostate cancer