Background: With increasing life expectancy, the number of elderly patients seeking curative treatment for prostate cancer is rising. Radical prostatectomy (RP), particularly the robotic approach, has proven feasible in older men. This study analyzes trends in RP among men aged ≥ 75 years of age in Germany between 2006 and 2022. Materials and Methods: This nationwide retrospective study used German hospital billing data, including 444,102 RPs from 2006 to 2022. Outcomes were in-hospital mortality, transfusion rates, and the length of stay. Results: The mean age of RP increased from 64.96 ± 6.07 years in 2006 to 66.53 ± 6.88 years in 2022 (p < 0.001). The proportion of men of men ≥ 75 years rose from 3% (935 of 28,374) to 12% (3505 of 29,363) (p < 0.001). In 2022, patients ≥ 75 had longer hospital stays (8.15 ± 4.63 versus 7.57 ± 3.97 days; p < 0.001), higher mortality (0.3% (9 of 3014) versus 0.1% (26 of 26,349); p = 0.003), and higher transfusion rate (5% (188 of 3505) versus 2% (641 of 25,858); p < 0.001). Patients ≥ 75 years underwent open RP more frequently than robotic RP (14% (1110 of 7831) versus 11% (2227 of 20,205); (p < 0.001)), were more frequently treated in nonuniversity hospitals (76% (2643 of 3462) versus 73% (18,534 of 25,344); p < 0.001), and less often in high-volume hospitals (> 199 cases/year) in 2022 (11% (1495 of 13,200) versus 13% (1999 of 15,609); (p < 0.001)). Conclusions: The proportion of people ≥ 75 years is continuing to rise, which leads to more patients with poorer functional outcomes. The longer hospital stays, higher transfusion rates, and mortality are nevertheless within acceptable limits.