Age-stratified trajectories of patient-reported outcomes and perioperative safety after robot-assisted radical prostatectomy: a prospective multicenter cohort study

As life expectancy increases, a growing number of older adults undergo radical prostatectomy for localized prostate cancer; however, longitudinal age-specific functional outcomes remain insufficiently characterized. We conducted a prospective multicenter cohort study evaluating age-stratified trajectories of patient-reported outcomes (PROs) assessed using the Expanded Prostate Cancer Index Composite (EPIC) and perioperative complications following robot-assisted radical prostatectomy (RARP). A total of 604 patients were categorized into three age groups (< 65, 65-74, and ≥ 75 years). PROs were assessed using the EPIC at baseline and at 1, 3, 6, and 12 months postoperatively, and longitudinal changes were analyzed using linear mixed-effects models. Urinary function declined transiently after surgery in all age groups and substantially recovered by 12 months, with no significant differences between men aged ≥ 75 years and younger patients. Sexual function decreased irrespective of age, although younger patients maintained higher absolute scores after nerve-sparing procedures. In contrast, sexual bother demonstrated an age-dependent pattern, with minimal change observed in men aged ≥ 75 years. Perioperative complication rates did not differ significantly across age groups. These findings suggest that chronological age alone should not preclude consideration of RARP in appropriately selected elderly patients and provide evidence supporting individualized surgical decision-making in an aging population.