Study Finds Larger Prostates Lead to Better Disease Grades in Robotic Prostate Surgery

"Despite these challenges, patients with larger prostates showed more favorable pathological outcomes, with no significant differences in functional outcomes or rates of biochemical recurrence," the researchers wrote in the journal The Prostate.

Robotic-assisted radical prostatectomy is a commonly used surgical approach for treating prostate cancer in the United States, with prostate size often cited as a factor influencing RARP outcomes. However, many studies have been limited to small patient populations. Ahmed Gamal, AdventHealth Global Robotics Institute, Celebration, Florida, USA, and colleagues aimed to evaluate both the functional and oncologic outcomes of RARP in patients with very large prostate sizes.

For this purpose, the researchers divided 375 RARP patients into two groups based on prostate size: Group 1, with prostates larger than 150g, and Group 2, with prostates smaller than 50g. Perioperative variables were matched using 1:3 propensity score matching, and postoperative variables were analyzed for significant differences in outcomes between the groups. The variables studied included estimated blood loss (EBL), operative time, catheter time, hospitalization duration, postoperative complications, pathological staging, positive surgical margins (PSM) rates, biochemical recurrence (BCR), as well as potency and continence rates.

The investigation uncovered the following findings:

• Both groups exhibited similar preoperative characteristics.
• Patients with larger prostates (Group 1) had higher blood loss (EBL), longer console time, and more days with a catheter.
• There was no significant difference in the overall postoperative complications (Clavien-Dindo).
• Pathological outcomes showed that patients with larger prostates had 69.7% more pT2 disease and 12.1% lower rates of positive surgical margins (PSM).
• There was no significant difference in the functional outcomes between the groups.

The study highlights that prostate size plays a significant role in influencing various surgical outcomes. Larger prostates were associated with more favorable pathological results, including lower-grade disease, and reduced rates of extraprostatic extension and positive surgical margins.

"These findings suggest that larger prostates may offer more advantageous oncological outcomes. However, the study also observed increased perioperative challenges, such as higher blood loss and longer console time, associated with larger prostates. Despite these challenges, there were no significant differences in biochemical recurrence or functional outcomes, such as potency and continence, between the groups," the researchers concluded.

Reference:

Gamal, A., Moschovas, M. C., Jaber, A. R., Saikali, S., Reddy, S., Kunta, A., Sandri, M., Rogers, T., & Patel, V. Functional and Oncological Outcomes of Very Large Prostate Sizes Post Robotic Radical Prostatectomy: A Propensity Score-Matched Analysis. The Prostate, e24848. https://doi.org/10.1002/pros.24848