Prostate cancer is most often diagnosed in men over 65, and many men in their 70s ask whether surgery is still a sensible option. There is no single age limit for robotic prostatectomy. What matters more is how fit a man is, how long he is likely to live and how his cancer is likely to behave.
Why age alone is not the answer
Two men of the same age can be very different in health. One may be active, with no serious medical conditions. Another may have heart disease, diabetes or breathing problems. The first may cope very well with surgery, while the second may face higher risks.
For this reason, specialists usually think about:
- biological age: how fit and healthy you are
- life expectancy: based on general health, not just age
- the cancer: its grade, stage and likely course
How the cancer affects the decision
Prostate cancer often grows slowly. For an older man with low-risk cancer, the cancer may never cause problems in his lifetime. Active surveillance or watchful waiting may be the better choice. Our guide to active surveillance explains how monitoring works.
For an older man who is fit and has intermediate or high-risk cancer, the cancer is more likely to cause problems if untreated. In this case, treatment that aims to cure, such as robotic prostatectomy or radiotherapy, may be worthwhile. NICE guidance on prostate cancer recommends taking life expectancy and other health conditions into account when offering treatment.
Fitness for surgery
During robotic prostatectomy, the patient lies with the head tilted downwards for some time. This puts extra pressure on the heart and lungs. Before surgery, the team will usually assess:
- heart health, sometimes with an ECG or heart scan
- lung function
- kidney function
- blood pressure and diabetes control
- any previous abdominal operations
- mobility and day-to-day activity levels
Some hospitals use a formal fitness test before major surgery, such as an exercise bike test that measures how well the heart and lungs respond to effort. The results help the team judge risk and plan care after the operation.
Recovery in older men
Older men often recover well from robotic surgery, but some aspects may take longer:
- Continence: recovery of bladder control may be slower in older men. Pelvic floor exercises are especially important. Our step-by-step pelvic floor guide explains how to do them.
- Erections: erectile function before surgery is a strong guide to function afterwards. Men with existing erection problems are less likely to regain full function.
- Energy: tiredness can last several weeks.
Getting fitter before surgery
Improving fitness in the weeks before surgery can help. This might include daily walking, breathing exercises, good nutrition, stopping smoking and reducing alcohol. Even a few weeks of regular activity can improve stamina and help recovery afterwards. A physiotherapist or your GP can suggest a safe programme.
Weighing up the options
For older men, the choice is often between surgery, radiotherapy and monitoring. Questions to consider include:
- How likely is my cancer to affect my health in the next ten to fifteen years?
- How fit am I for an operation?
- How important is it to me to avoid side effects such as leakage?
- How would I feel about living with a cancer that is being monitored?
Prostate Cancer UK has resources to help men weigh these choices.
A shared decision
The right choice comes from a frank discussion between you, your family and your specialists. Age should be part of the conversation, but it should not be the only factor. Many men find it helpful to bring a family member, who can help weigh up the options and support recovery if surgery goes ahead.
Professor Prokar Dasgupta assesses men of all ages for robotic surgery at The London Clinic. Our page on radical robotic prostatectomy explains the operation. Please contact the clinic to arrange a consultation.