Urologists acknowledge the importance of considering prostate size when selecting treatment options for localized prostate cancer, highlighting the influence of factors like age, preoperative urinary symptoms, cancer stage and grade, and prostate size on the choice of treatment. Specifically, the study focuses on patients with larger prostates (>150g) who may not be ideal candidates for nonsurgical treatments due to potential urinary complications associated with their prostate size.
The methodology involves a thorough analysis of preoperative characteristics, perioperative and postoperative variables, and functional and oncological outcomes across four groups categorized by prostate size. The statistical analysis employs appropriate tests and models to assess the significance of the findings.
The results reveal several noteworthy associations. Patients with larger prostates exhibit increased blood loss, longer operative times, and delayed recovery of continence after RARP. Additionally, the study identifies a higher rate of Clavien-Dindo III complications in patients with larger prostates, possibly linked to their older age and higher pre-operative comorbidity index.
In terms of oncological outcomes, larger prostates are associated with higher rates of pT2, lower rates of positive surgical margins, and lower Pathology ISUP grade group 1. The study also observes a significant difference in biochemical recurrence rates over 24 months, with larger prostates showing lower rates.
The analysis of functional outcomes indicates that patients with larger prostates experience poorer urinary continence and sexual function recovery. The study attributes the lower rate of full nerve sparing in larger prostates to the challenging nature of performing nerve-sparing techniques in these cases, and the worse baseline function for these patients preoperatively.
It is worth mentioning that approaching large-volume prostates is always challenging. The initial identification of the ureters and the lateral dissection of the bladder are crucial steps to achieve the correct anatomical landmarks to avoid complications. In addition, minimizing the bladder tissue dissection is essential for the appropriate bladder reconstruction before the anastomosis, especially because most patients usually have a large bladder defect.
In conclusion, this study significantly contributes to the existing literature by presenting a comprehensive analysis of the impact of prostate size on RARP outcomes. The large cohort and meticulous examination of various parameters enhance the validity and relevance of the findings, making it a valuable resource for clinicians involved in prostate cancer management.
Written by: Abdel Rahman Jaber,1 Marcio Covas Moschovas,2 Shady Saikali,1 Ahmed Gamal,1 Roshane Perera,1 Travis Rogers,1 Ela Patel,3 Marco Sandri,3 Derya Tilki,4 Vipul Patel2
- AdventHealth Global Robotics Institute, Celebration, FL, USA.
- AdventHealth Global Robotics Institute, Celebration, FL, USA; University of Central Florida, Orlando, FL, USA.
- Big and Open Data Innovation Laboratory, University of Brescia, Brescia, Italy.
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.