While advances in surgical techniques and modalities seem to facilitate recovery of urinary continence (UC) after radical prostatectomy (RP), old age is still considered as a risk factor for delay or failure to achieve UC and many older men with a significant disease often hesitate to receive RP due to the risk of urinary incontinence. We aimed to evaluate the contemporary trends of RP in the elderly aged over 70 years and compare its predictors for the recovery of UC over time with those for patients aged 70 years or less.

Among men who underwent RP in our institution, a total of 2,301 men with eligible criteria were included in the analyses. Patients were divided into two groups based on age at surgery (>70 vs ≤70) and four study periods by surgery year (2004-2006, 2007-2009, 2010-2012, and 2013-2015). Clinicosurgical characteristics of both age groups were compared according to the study period and the recovery rate of UC at 3 and 12 months after RP was compared between both groups by the study period. Multivariate logistic regression analyses were performed to identify the predictors for the recovery of UC in each age group and the effects of each predictor on the recovery of UC at 12 months were compared over time between both age groups.

Of the entire cohort, patients aged >70 years accounted for 26.5% (610/2,301) and gradually increased over time up to 30.0% in 2013-2015 (P <0.001). While the use of robot-assisted RP increased over time in each age group, older patients received robot-assisted RP 8.3% lower than younger patients in the last quarter of the study period (P = 0.003). Within older patients, the rate of robot-assisted RP and neurovascular bundle (NVB) saving continued to rise up to 80.0% and 67.4% in 2013-2015 and pathologic Gleason score became higher over the study period. On the other hand, prostate volume and membranous urethral length (MUL) significantly decreased over the study period. While the recovery rate of UC significantly improved over time in each age group, overall recovery rate of UC at 12 months (3 months) in patients aged >70 years was lower than that in those ≤70 years (81.5% (52.6%) vs 88.6% (60.9%); P <0.001, respectively). However, from the second quarter of the study period, the difference of recovery rate at 12 months between both age groups significantly decreased over time (P <0.001), whereas the gap at 3 months was constant over the study period (Fig. 1). Among younger patients, age at surgery, robot-assisted RP, prostate volume, and MUL were founded to be the predictors for the achievement of UC at both 3 and 12 months, and NVB saving only for the recovery at 12 months. In contrast, only age and MUL were revealed to be the predictors for the achievement of UC at 3 and 12 months in patients aged >70 years (Table 1).

There has been an increasing trend of the proportion of subjects aged >70 years among the patients who received RP over the last 12 years. While several clinicosurgical characteristics such as NVB saving and robot-assisted RP are associated with the recovery of UC in younger patients, only age and MUL are the predictors for the recovery in those aged > 70 years.

Based on our contemporary RP series, the proportion of patients aged >70 years gradually increased up to 30.0% over 12 years, and the use of robot-assisted RP and NVB saving was also expanded in this population. Although the recovery rate of UC at 3 and 12 months significantly improved over time in patients aged >70 years, it was still lower than that in younger patients. Unlike younger patients, only age and MUL were the predictors for the recovery of UC in those aged >70 years.