Prostate Volume and Its Correlation with Histopathological Outcomes in Prostate Cancer

Abstract

Introduction: There is a paucity of data investigating the relationship between histopathological variables of oncologic importance and prostate volume, and we aimed to investigate this. Patients and Methods: 2,207 consecutive patients who underwent robotic-assisted radical prostatectomy were studied. Preoperative demographic and both pre- and postoperative histopathological parameters were compared among the small (<40 cm³), intermediate (40–70 cm³), and large (>70 cm³) prostate groups. Results: Patients with smaller prostates were younger, had slightly lower BMIs, and lower prostate-specific antigen (PSA) levels than those with larger prostates (p < 0.001). They also had worse histopathological criteria (Gleason, core positivity, and maximum percent cancer) on preoperative biopsy and had worse radical specimen Gleason sums (p < 0.001), percent cancer (p < 0.001), and pathological stage (p = 0.016). 11.5% of the men in the small prostate group suffered a positive surgical margin (PSM) compared to 8.3 and 5.6% in the intermediate and large prostate groups, respectively (p = 0.008). Basilar, posterolateral, and multifocal PSMs were commoner in the small prostate group. Conclusions: Younger men have smaller prostates and worse preoperative histopathological parameters despite lower PSA values. Men with small prostates undergoing robotic-assisted radical prostatectomy have worse final Gleason sums, tumour volume, extraprostatic extension, and PSM rates than those with larger prostates.

Impact of prostate volume on oncologic, perioperative, and functional outcomes after radical prostatectomy

“…Several studies have shown a lower rate of PSM in patients with larger prostates . Confirmingly, we saw a trend towards lower PSM in patients with larger glands, however this finding was not significant.…”

“…Other studies confirmed these results . Smaller glands showed higher percentage of cancer than larger ones . This might favour an infiltration of the capsule and lead to a higher rate of PSM and ECE and can lead to a worse BCR‐free survival.…”

Perineural invasion status, Gleason score and number of positive cores in biopsy pathology are predictors of positive surgical margin following laparoscopic radical prostatectomy

“…reported that men with smaller prostates had larger tumor volumes, were less organ confined, had more EPE, and experienced more biochemical recurrence. Sooriakumaran et al 30. found that small prostate volume had a higher rate of PSM in patients undergoing RP.…”

Robotic Prostatectomy Has a Superior Outcome in Larger Prostates and PSA Density Is a Strong Predictor of Biochemical Recurrence

“…Whilst larger prostates present a technical challenge at robotic prostatectomy and are associated with a longer operative time [ 6 ], greater blood loss, and increased postoperative complications [ 3 , 7 ], they are associated with a superior oncological outcome in terms of reduced extraprostatic disease, reduced positive margin rate [ 8 – 14 ], and decreased biochemical recurrence rate [ 3 ]. In this cohort there was no significant difference between larger prostates (≥75 g) and smaller prostates (<75 g) in terms of the preoperative staging; however, the two groups were markedly different postoperatively.…”