A large prostate at radical retropubic prostatectomy does not adversely affect cancer control, continence or potency rates

Abstract

The response rate to the questionnaire was 78% (344 men). Patients with prostates of >75 g were older, with a median (range) age of 65 (51-74) years, than the other group, at 61 (40-76) years ( P = 0.01), and had higher initial prostate-specific antigen (PSA) levels, at 9.6 (3.4-37.8) and 7.6 (0.1-30.0) ng/mL, respectively ( P = 0.001). Tumours within larger prostates were of a lower stage ( P = 0.035), lower Gleason grade (median 6 and 7, P = 0.015), of smaller volume (median 1.0, 0.1-12.4; and 1.5, 0.1-21.1 mL; P = 0.04) and more often 'clinically insignificant' (23% and 6%, P = 0.001). There was no difference in the number or distribution of positive surgical margins. For a limited median follow-up of 20-25 months, patients with prostates of >75 g were less likely to have biochemical recurrence (5% vs 24%, P < 0.001). Potency and continence rates were similar between the groups. CONCLUSIONSProstate size at RRP does not affect the risk of impotence or incontinence afterward. A prostate of >75 g is associated with a lower likelihood of PSA-relapse, potentially as a result of lead-time bias. While an enlarged prostate may contraindicate other potentially curative cancer treatments, the outcomes of RRP appear to be unaffected. KEYWORDSprostatic neoplasm, volume, prostatectomy, incontinence, erectile dysfunction OBJECTIVESTo determine the effect of a large prostate at radical retropubic prostatectomy (RRP) on the pathological outcome, biochemical recurrence rates, potency and continence. PATIENTS AND METHODSFrom a database of 440 patients treated with RRP, retrospective information was obtained on prostate weights, patient and tumour characteristics, and follow-up. Potency and continence after RRP was obtained using a self-reported validated questionnaire. Patients with prostates of >75 or ≤ 75 g were compared. RESULTSThe median (range) prostate size was 87 (76-182) and 42 (4.1-75) g in the two groups.

Race and prostate weight as independent predictors for biochemical recurrence after radical prostatectomy

“…Similarly, higher prostate weight has been found to be protective against BCR. [22][23][24][25] Our finding that increased prostate weight is an independent predictor for improved recurrence-free survival is in concordance with these reports. Of note, the effect of prostate weight was not driven by outliers, as prostate weight remained a significant independent factor when the analysis was limited to men with a prostate weight between 20 and 100 grams (data not shown).…”

“…Increased prostate weight would lead to higher PSA values and, thus, these patients might be subjected to biopsy earlier than patients with small prostates. [23][24][25] However, Freedland et al 22 argued that this phenomenon could not account for the effect of prostate weight in their study, as an analysis of only the patients who had a palpable nodule on prostate biopsy still showed prostate weight to be a significant independent predictor for higher recurrence-free survival.…”

A case report of radical prostatectomy in large prostate volume

“…D'amico büyük prostat varlığının preoperatif PSA seviyelerini artırdığını ancak cerrahi ve patolojik açıdan daha iyi sonuçlara sahip olduğunu belirtmiştir (12). Foley ve arkadaşları da 2003 yılındaki çalışmalarında prostat boyutunun büyümesi ile klinik önemsiz prostat kanseri saptanma olasılığının arttığını, büyük prostat volümünde PSA seviyelerinin yüksek olmasına rağmen biyopsideki Gleason skorlarının düşük olduğunu bunun da nedeninin yüksek prostat volümlü olgularda tümör volümünün daha düşük olmasına bağlanmaktadır (13). Çalışmaların büyük kısmında benzer sonuçlar yer almaktadır.…”

“…Çalışmaların büyük kısmında benzer sonuçlar yer almaktadır. Küçük volümlü olgularda tümörün daha agresif seyrettiği ve cerrahi sınır pozitifliğinin daha sık gözlendiği bildirilmekle birlikte büyük prostatın rekürrensle ilişkisinin bulunmadığı Adress for correspondence: Taha Numan Yıkılmaz, Dr. Abdurrahman Yurtaslan Ankara Onkoloji Eğitim Ve Araştırma Hastanesi, Ankara, Türkiye e-mail:numanyikilmaz@gmail.com Available at www.actaoncologicaturcica.com Copyright ©Ankara Onkoloji Hastanesi sadece cerrahi teknikte zorluğa yol açtığı bildirilmiştir (2,7,10,13). Olgumuzda da literatüre benzer olarak büyük prostat volümüne rağmen cerrahi sınır pozitifliği görülmemiş ancak cerrahinin zorluğuna bağlı nörovasküler demet korunamamıştır ve hasta postoperatif empotan durumdadır.…”

Tumor Volume, Tumor Percentage Involvement or Prostate Volume: Which Is Predictive of Psa Recurrence?

“…12,13 Men with smaller prostates have been shown to have higher grade and more advanced disease 14 and men with larger prostates have been shown to have lower rates of PSAR. 15,16 Currently there is no consensus on the utility of TV, TPI and PV in the prediction of PSAR. The goal of this study was to examine the effects of TV, TPI, and PV on PSAR following radical prostatectomy (RP) in a large patient population.…”