Elderly Prostate Cancer Patients Treated with Robotic Surgery Are More Likely to Harbor Adverse Pathology Features and Experience Disease Progression: Analysis of the Prognostic Impact of Adverse Pathology Risk Score Patterns Using Briganti’s 2012 No

<b>Background/Objectives:</b> Prostate cancer (PCa) is prevalent among men over 70. Treatment may involve interventions like radical prostatectomy. The objective of this study was to investigate the combination of adverse pathology patterns on PCa progression through the Briganti 2012 nomogram and EAU risk classes in elderly patients treated with robotic surgery. <b>Methods</b>: A cohort of 1047 patients treated from January 2013 to December 2021 was categorized as being older if aged 70 or above. The adverse pathology risk scores were ranked from zero to three. These scores were then analyzed for correlations with the Briganti 2012 nomogram via EAU risk groups and for PCa progression. <b>Results</b>: Overall, older age was detected in 287 patients who had higher rates of adverse pathology features combined into a pattern risk score of 3. Within each age group, the adverse pathology risk score patterns were positively predicted by the Briganti 2012 nomogram across EAU prognostic groups. After a median (95% CI) follow-up period of 95 months, PCa progression occurred in 237 patients, of whom 68 were elderly and more likely to progress as adverse pathology patterns increased, particularly for a risk score of 3 (<i>p</i> < 0.0001), which was almost three times higher than that in younger patients (<i>p</i> < 0.0001). <b>Conclusions</b>: Managing PCa in elderly patients is challenging due to their increasing life expectancy. The Briganti 2012 nomogram effectively predicts disease progression in this population. Elderly prostate cancer patients have higher severe pathology rates predicted independently by the Briganti 2012 nomogram, with nearly triple the risk of progression compared to that in younger cases, necessitating tailored treatment approaches.