Prostate Size is Associated With Surgical Difficulty but Not Functional Outcome at 1 Year After Radical Prostatectomy
- 30 September 2009
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 182 (3), 949-955
- https://doi.org/10.1016/j.juro.2009.05.029
Abstract
We assessed the impact of prostate size on operative difficulty as measured by estimated blood loss, operating room time and positive surgical margins. In addition, we assessed the impact on biochemical recurrence and the functional outcomes of potency and continence at 1 year after radical prostatectomy as well as postoperative bladder neck contracture. From 1998 to 2007, 3,067 men underwent radical prostatectomy by 1 of 5 dedicated prostate surgeons with no neoadjuvant or adjuvant therapy. Pathological specimen weight was used as a measure of prostate size. Cox proportional hazards and logistic regression analysis was used to study the association between specimen weight, and biochemical recurrence and surgical margin status, respectively, controlling for adverse pathological features. Continence and potency were analyzed controlling for age, nerve sparing status and surgical approach. With increasing prostate size there was increased estimated blood loss (p = 0.013) and operative time (p = 0.004), and a decrease in positive surgical margins (84 of 632 [14%] for 40 gm or less, 99 of 862 [12%] for 41 to 50 gm, 78 of 842 [10%] for 51 to 65 gm, 68 of 731 [10%] for more than 65 gm, p <0.001). Biochemical recurrence was observed in 186 of 2,882 patients followed postoperatively and was not significantly associated with specimen weight (p = 0.3). Complete continence was observed in 1,165 of 1,422 patients (82%) and potency in 425 of 827 (51%) at 1 year. Specimen weight was not significantly associated with potency (p = 0.8), continence (p = 0.08) or bladder neck contracture (p = 0.22). Prostate size does not appear to affect biochemical recurrence or 1-year functional results. However, estimated blood loss and operative time increased with larger prostate size, and positive surgical margins are more often observed in smaller glands.Keywords
This publication has 24 references indexed in Scilit:
- The Impact of Prostate Size on Perioperative Outcomes in a Large Laparoscopic Radical Prostatectomy SeriesJournal of Endourology, 2009
- The Impact of Prostate Size on Urinary Quality of Life Indexes Following Laparoscopic Radical ProstatectomyJournal of Urology, 2008
- The effect of prostate weight on the outcomes of laparoscopic radical prostatectomyBJU International, 2007
- Recovery of Urinary Continence Following Radical Prostatectomy: The Impact of Prostate Volume—Analysis of Data From the CaPSURE™ DatabaseJournal of Urology, 2007
- The Impact of Prostate Size in Laparoscopic Radical ProstatectomyEuropean Urology, 2005
- Hepatic Resection: The Last Surgical Frontier for Colorectal CancerJournal of Clinical Oncology, 2005
- VARIATIONS AMONG HIGH VOLUME SURGEONS IN THE RATE OF COMPLICATIONS AFTER RADICAL PROSTATECTOMY: FURTHER EVIDENCE THAT TECHNIQUE MATTERSJournal of Urology, 2005
- Should a Positive Surgical Margin Following Radical Prostatectomy be Pathological Stage T2 or T3? Results From the SEARCH DatabaseJournal of Urology, 2003
- Pretreatment Total Testosterone Level Predicts Pathological Stage in Patients With Localized Prostate Cancer Treated With Radical ProstatectomyJournal of Urology, 2003
- Risk Factors for Urinary Incontinence after Radical ProstatectomyJournal of Urology, 1996