Impact of prostate weight on radical prostatectomy outcomes.

Background: The management of localized prostate cancer in patients with large prostates is controversial.

Objective: To investigate the impact of prostate weight on radical prostatectomy outcomes.

Methods: The files of 244 patients who underwent radical prostatectomy were reviewed. Data were collected on patient and tumor characteristics and on oncological, urinary and erectile function outcomes. Results were compared between patients with prostates weighing < or = 60 g or > 60 g.

Results: A prostate weight of > 60 g was documented in 25% of the patients. There was no difference in clinical stage distribution between patients with smaller and patients with larger prostates. Patients with a larger prostate were characterized preoperatively by higher levels of prostatespecific antigen (9.8 vs. 7.3 ng/ml, P = 0.009), lower tumor grade (biopsy Gleason score < or = 6: 77.6% vs. 90.2% P = 0.04), and a higher incidence of moderate-severe urinary symptoms (69.8 vs. 38.8%, P = 0.0003). Analysis of pathological stage distribution yielded a higher proportion of lower stage disease and a lower incidence of positive margins in the large-prostate group (11.7 vs. 25.8%, P = 0.024). There were no statistically significant between-group differences in the rate of persistent postoperative detectable PSA, biochemical recurrence, urinary incontinence and erectile function.

Conclusions: The outcomes of radical prostatectomy in patients with large prostate are favorable in terms of cancer characteristics despite their higher preoperative PSA levels, and comparable to that in patients with small prostate in terms of urinary continence and erectile function. Surgery may be particularly beneficial in patients with preoperative urinary symptoms. Hence, radical prostatectomy should not be discouraged as a treatment for localized prostate cancer in patients with sizeable prostates.