Q: I'm 77 years old and planning to have a radical prostatectomy. Are incontinence and erectile dysfunction less likely with a robotic procedure?

A: My first question is whether you know for sure that radical prostatectomy is the best option. There's a real chance that you could develop problems with continence and potency after the procedure.

For years, men over age 70 weren't considered candidates for radical prostatectomy because they were unlikely to die of the prostate cancer; a problem like heart attack or stroke was more likely to be fatal. That advice is being challenged by baby boomers, who are living longer.

Still, it's important to consider your overall health—can you expect to live another 10 years? If not, you may be better off skipping a procedure that could do more harm than good.

Before you proceed with surgery, get a second opinion. Two treatments that have better short-term continence and potency rates are external beam radiation and brachytherapy. If radical prostatectomy is the best choice, a robotic approach is certainly an option.

A recent study in The Journal of Urology looked specifically at elderly men undergoing robotic radical prostatectomy. The researchers projected that one year after the procedure, men age 75 and older had a 59 percent chance of being pad free. They also had a 46 percent chance of being potent if a bilateral nerve-sparing procedure was used.

Publication Review By: H. Ballentine Carter, M.D.

Published: 21 Jun 2011

Last Modified: 01 Jul 2011