Younger Age Is Associated With Early Urinary Continence Recovery After Robot-Assisted Radical Prostatectomy.

OBJECTIVES

To evaluate whether an age < 55 years is independently associated with early urinary continence recovery after robot-assisted radical prostatectomy (RARP) in a large multi-institutional Japanese cohort.

METHODS

The cohort comprised 5349 patients aged < 75 years with clinically localized prostate cancer (cT1-2N0M0) who underwent RARP at Japanese tertiary care centers from August 2011 to April 2023. The primary analysis consisted of a 1:1 propensity score-matched comparison between men aged < 55 and 55-74 years. Covariates used for matching included American Society of Anesthesiologists physical status, clinical T stage, biopsy International Society of Urological Pathology grade group, prostate-specific antigen, prostate volume, nerve-sparing status, pelvic lymph node dissection, and surgical approach. Early urinary continence, biochemical recurrence-free survival, and surgical outcomes were evaluated using logistic regression and Cox proportional hazards models in the matched cohort.

RESULTS

After propensity score matching, 158 well-balanced matched pairs were generated. A younger age (< 55 years) was significantly associated with higher odds of early continence at 1 month (odds ratio: 1.66, 95% confidence interval [CI]: 1.04-2.65) and 3 months (odds ratio: 2.22, 95% CI: 1.32-3.73). Five-year biochemical recurrence-free survival was similar between men aged < 55 and 55-74 years (86.2% vs. 84.8%). In an exploratory three-group analysis, continence recovery showed a graded age-related pattern.

CONCLUSIONS

In this large Japanese cohort, an age < 55 years was independently associated with early urinary continence recovery after RARP without compromising oncological outcomes. These findings provide age-specific evidence to support preoperative counseling and surgical decision-making in younger patients.