PD27-12: Assessing the Role of Frailty Status on Oncologic and Functional Outcomes in Patients Treated with Robot-Assisted Radical Prostatectomy for Localized Prostate Cancer

Giuseppe Rosiello*, Simone Scuderi, Giorgio Gandaglia, Elio Mazzone, Francesco Barletta, Daniele Robesti, Riccardo Leni, Lorenzo Toneatto, Antony Pellegrino, Leonardo Quarta, Armando Stabile, Milano, Italy, Vito Cucchiara, Milan, Italy, Gianmarco Colandrea, Milano, Italy, Sabrina Comana, Enrico Camisassa, Milan, Italy, Nicola Fossati, Lugano, Switzerland, Federico Dehò, Varese, Italy, Francesco Montorsi, Alberto Briganti, Milano, Italy

Introduction: Frailty is a predictor of adverse outcomes in several surgical procedures. Its role in prostate cancer (PCa) patients undergoing robot-assisted radical prostatectomy (RARP) has not been tested yet. Assessing frailty is key for identifying the proper candidate for surgery and to eventually tailor proper pre-operative management. To address this void, we aimed at evaluating the role of frailty on oncologic and functional outcomes in PCa patients treated with RARP +extended PLND.

Methods: We relied on a prospective database including 2859 consecutive patients who underwent RARP ± ePLND for localized PCa from November 2016 to July 2021 at a tertiary center. The Modified Frailty Index (MFI) was used to identify frail patients. Biochemical recurrence (BCR) was defined as two consecutive PSA =0.2ng/ml. Urinary continence (UC) was defined as use of one safety pad or no pads. Erectile function (EF) was evaluated using the International Index of Erectile Function Questionnaire (IIEF) and EF recovery was defined as IIEF >17. Cumulative incidence plots graphically depicted UC and EF recovery after surgery according to frailty status. Multivariable competing-risks analyses tested the association between frailty status and UC and EF recovery after RARP.

Results: Of 2859 analyzed patients, 316 (11%) were frail according to MFI. Median age was 63 vs 66 years in fail vs non-fail patients. Median PSA was 6.5 vs 6.2 ng/mL and median BMI was 25 vs 26 kg/m2 in frail vs non-frail patients (p < 0.01). No differences between frail and non-frail patients were reported with regards to the D’Amico risk groups (p=0.2) and Preoperative International Prostatic Symptoms Score (p=0.3). At median follow-up of 46 months, 457 (16%) patients experienced BCR. While frailty status was not associated with the risk of BCR, 12 months cumulative incidence of UC and EF recovery was 65% (95%CI 57-71%) vs 81% (95%CI 79-84%) and 11% (95%CI 6.4-16%) vs 21% (95%CI 19-23%) in frail vs non-frail patients (p < 0.001). At multivariable analyses, frailty status was associated with the risk of urinary incontinence [Hazard ratio (HR): 0.7; p<0.001] and erectile dysfunction (HR: 0.52; p<0.001) after RARP.

Conclusions: Patient frailty is strongly associated with worse functional outcomes after surgery. Thus, preoperative assessment of frailty during preoperative counseling is key to identify the proper candidate for surgery and those men who may benefit from an integrated pre-operative multidisciplinary approach in order to revert or improve their frailty status.

Source of Funding: no funding