title: A large prostate at radical retropubic prostatectomy does not adversely affect cancer control, continence or potency rates.
abstract: OBJECTIVE
  To determine the effect of a large prostate at radical retropubic prostatectomy (RRP) on the pathological outcome, biochemical recurrence rates, potency and continence.
  
  
  METHODS
  From a database of 440 patients treated with RRP, retrospective information was obtained on prostate weights, patient and tumour characteristics, and follow-up. Potency and continence after RRP was obtained using a self-reported validated questionnaire. Patients with prostates of > 75 or < or = 75 g were compared.
  
  
  RESULTS
  The median (range) prostate size was 87 (76-182) and 42 (4.1-75) g in the two groups. The response rate to the questionnaire was 78% (344 men). Patients with prostates of > 75 g were older, with a median (range) age of 65 (51-74) years, than the other group, at 61 (40-76) years (P = 0.01), and had higher initial prostate-specific antigen (PSA) levels, at 9.6 (3.4-37.8) and 7.6 (0.1-30.0) ng/mL, respectively (P = 0.001). Tumours within larger prostates were of a lower stage (P = 0.035), lower Gleason grade (median 6 and 7, P = 0.015), of smaller volume (median 1.0, 0.1-12.4; and 1.5, 0.1-21.1 mL; P = 0.04) and more often 'clinically insignificant' (23% and 6%, P = 0.001). There was no difference in the number or distribution of positive surgical margins. For a limited median follow-up of 20-25 months, patients with prostates of > 75 g were less likely to have biochemical recurrence (5% vs 24%, P < 0.001). Potency and continence rates were similar between the groups.
  
  
  CONCLUSIONS
  Prostate size at RRP does not affect the risk of impotence or incontinence afterward. A prostate of > 75 g is associated with a lower likelihood of PSA-relapse, potentially as a result of lead-time bias. While an enlarged prostate may contraindicate other potentially curative cancer treatments, the outcomes of RRP appear to be unaffected.
authors.affiliation: Prostate Cancer Research Laboratory, The Institute of Urology and Nephrology, University College London, London, UK. charlotte_foley@hotmail.com
authors.forename: C L
authors.initials: CL
authors.lastname: Foley
authors.forename: S R J
authors.initials: SR
authors.lastname: Bott
authors.forename: K
authors.initials: K
authors.lastname: Thomas
authors.forename: M C
authors.initials: MC
authors.lastname: Parkinson
authors.forename: R S
authors.initials: RS
authors.lastname: Kirby
mesh_terms: D000328:Adult; D000368:Aged; D007172:Erectile Dysfunction / Q000209:etiology / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology*; D011467:Prostate / Q000473:pathology*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology / Q000473:pathology*