Surgical Tolerability and Frailty in Elderly Patients Undergoing Robot-Assisted Radical Prostatectomy: A Narrative Review

Abstract

Robot-assisted radical prostatectomy (RARP) has now become the gold standard treatment for localized prostate cancer. There are multiple elements in decision making for the treatment of prostate cancer. One of the important elements is life expectancy, which the current guidelines recommend as an indicator for choosing treatment options. However, determination of life expectancy can be complicated and difficult in some cases. In addition, surgical tolerability is also an important issue. Since frailty may be a major concern, it may be logical to use geriatric assessment tools to discriminate ‘surgically fit’ patients from unfit patients. Landmark studies show two valid models such as the phenotype model and the cumulative deficit model that allow for the diagnosis of frailty. Many studies have also developed geriatric screening tools such as VES-13 and G8. These tools may have the potential to directly sort out unfit patients for surgery preoperatively.

Robot-Assisted Urological Oncology Procedures, Outcomes, and Safety in Frail Patients: A Narrative Review of Available Studies

“…The Vulnerable Elders Survey-13 (VES-13) and G8 are accurate and easy-to-use geriatric screening tools that can successfully determine the surgical fitness of frail patients and could potentially substitute life expectancy as the main criterion for choosing RARP as the preferred treatment option. 18 …”

“… 12 However, the vast majority of evidence for our review is derived from studies from the last 3 years. 1 - 11 , 14 - 18 As a consequence, no previous reviews are available to summarize the evidence concerning the outcomes of the most common robot-assisted urological procedures in frail patients, although these minimally invasive oncological operations have increased during the last decade.…”

“…Similarly, the G8 screening tool is one of the most commonly used frailty indexes for patients undergoing RARP. 5 , 16 , 18 , 21 The G8 scores range from 0 to 17 and the most used cutoff for frailty is ≤14, with a 65.2% sensitivity and 95.7% specificity for detecting vulnerable prostate cancer patients. 24 Alternatively, the VES-13 is an easy-to-use screening tool that can predict mortality in patients with prostate cancer.…”

“… 25 , 26 In patients who received androgen deprivation treatment, the sensitivity and specificity of VES-13 in predicting adverse events were 72.7% and 85.7% respectively, 27 when compared to the Comprehensive Geriatric Assessment, which is the gold standard for assessing the health status of patients but is time-consuming and requires the necessity for several types of experienced physicians, such as geriatrists, urologists, and physical therapists. 18 …”

The Association between Urine N-Glycome and Prognosis after Initial Therapy for Primary Prostate Cancer

“…The youngest patients were seen in the RP cohort. This is logical as RP is less suitable for frail and or unfit patients [26]. Next, iPSA gradually increased from the AS cohort to the RP cohort and the EBRT cohort.…”