The Impact of Prostate Volume in Open Radical Prostatectomy: A Single Centre Experience.

With more than 1.4 million newly diagnosed cases is the surgical treatment for prostate cancer an important therapy option, regardless of the prostate size. We retrospectively reviewed the records of 909 patients and found that surgery is feasible for very large prostates. Interestingly, these patients had lower positive margin rates. Background: Even the most experienced surgeons experience technical difficulties and challenges when operating on very large prostates, regardless of surgical technique. Our goal was to determine whether preoperative prostate volume has an impact on functional and oncological outcomes after open radical prostatectomy. Materials and Methods: We reviewed the records of 909 patients who underwent open radical prostatectomy by a single surgeon at our institution. Variables were compared across quartile distributions of prostate volume as defined by preoperative transrectal ultrasound examination, including group A with prostate volume < 30ccm 3, group B with prostate volume = 30ccm 3 and < 50ccm 3, group C with prostate volume = 50ccm 3 and < 70ccm 3 and group D with prostate volume = 70ccm3. Factors assessed in this analysis were patient age, preoperative prostate specific antigen (p-PSA), Gleason score, pathological stage, margin status, operative time, cystography leakage, early continence, biochemical recurrence (BCR)-free, and overall-survival (OS). The complication rates were classified using Clavien Dindo classification. Results: There were no statistically relevant differences between the groups considering preoperative factors such as age, p-PSA, Gleason score, and tumor stadium. Patients with a very large prostate had slightly higher percentage of anastomosis leakage, severe Clavien Dindo complication rates (= 3), longer operation time and severe early incontinence (IV °) rates, simultaneously having lower positive margin rates. Nevertheless, the early continence rates, BCR-free and OS were similar regardless of the prostate size. Conclusions: open radical prostatectomy for patients with very large prostate is a viable therapy option with slightly higher ur inary leakage-, ear ly incontinence- and complication-rates that takes slightly more operation time. However, the functional and oncological outcomes are similar when compared to smaller prostates. [ABSTRACT FROM AUTHOR]