Impact of Prostate Size on the Outcomes of Radical Prostatectomy: A Systematic Review and Meta-Analysis

Abstract

Background: The impact of prostate size on the radical prostatectomy outcome is not clear. Several published reports have shown conflicting results. Objectives: To investigate the effect of prostate size on the surgical, functional and oncological results of radical prostatectomy. Methods: A systematic review and meta-analysis were carried out in accordance with the PRISMA criteria. Finally, we investigated the research that reported on the impact of prostate size on radical prostatectomy outcome. The Review Manager (RevMan) software version 5.4 was utilized for statistical analysis. Results: Eighteen studies including 12,242 patients were included. Estimated blood loss was significantly less with smaller prostates (Z = 3.01; p = 0.003). The complications rate was 17% with larger prostates, compared to 10% for smaller prostates (Z = 5.73; p < 0.00001). Seventy-three percent of patients with a smaller prostate were continent within one month, compared to 64% with a larger prostate (Z = 1.59; p = 0.11). The rate of positive surgical margins was significantly higher with smaller prostates (20.2% vs. 17.8%). (Z = 2.52; p = 0.01). The incidence of biochemical recurrence was higher with smaller prostates (7.8% vs. 4.9%) (Z = 1.87; p = 0.06). Conclusion: Larger prostate size is associated with more blood loss and a higher rate of complications. However, the oncological outcome is better, compared to that in patients with smaller prostates. The impact of the size on the functional outcome is not clear.

Effect of large prostate volume on perioperative, oncological and functional outcomes after robotic radical prostatectomy: A retrospective clinical study

“…It has been reported in the literature that there is a trend towards better early continence after RARP in the patients with small prostate volumes. However, it should be noted that the definition of continence is different between studies and the parameters and query forms used in the evaluation of continence are not standardized (14). On the other hand, Yasui et al stated in their study that PV has no effect on the recovery of urinary functions after RARP (21).…”

“…In the meta-analysis examining prostate volume with oncological and functional results in the literature, it was seen that prostate volume sizes were different in different studies and there was no clear cutoff value. (14).…”

“…In these studies, it should not be ignored that prostate biopsies performed due to high PSA values in the patients with large PV with PSA elevation associated with diffuse benign prostatic hyperplasia potentially have better oncologic results by detecting earlier tumor stages (4). When the cases with localized prostate cancer are examined, it has been stated that the large amount of prostate tissue surrounding the cancerous lesion facilitates dissection and provides an advantage in terms of surgical margin negativity in the surgery of large-volume prostates (14). In our study, the mean preoperative PSA values, pathology results and D'amico risk classifications were similar between the two groups.…”

Prostate Volume Influence on Postoperative Outcomes for Patients Undergoing RARP: A Monocentric Serial Analysis of 500 Cases

“…In general, an elevated prostate volume, among other baseline parameters such as obesity, higher PSA, prostate pretreatment, and comorbidities, is considered to negatively influence the postoperative outcomes after prostatectomy [ 3 ]. Specifically, prostatectomy in men with large prostates is thought to be accompanied by more blood loss, as well as complications, yet favorable oncological results [ 4 ]. In total, (n = 28/500) 5.6% of the men in our cohort were readmitted within 90 days after RARP.…”

“…In general, an elevated prostate volume, among other baseline parameters such as obesity, higher PSA, prostate pretreatment, and comorbidities, is considered to negatively influence the postoperative outcomes after prostatectomy [ 3 ]. The specific influence of prostate volume on the prostatectomy outcomes is widely studied [ 4 ]. Regarding patient-reported outcome measures (PROMs), the operative technique, rather than prostate volume, influenced the results in a robotic simple prostatectomy population [ 5 ].…”