title: Prostate size is associated with surgical difficulty but not functional outcome at 1 year after radical prostatectomy.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Pettus
authors.forename: Timothy
authors.initials: T
authors.lastname: Masterson
authors.forename: Alexander
authors.initials: A
authors.lastname: Sokol
authors.forename: Angel M
authors.initials: AM
authors.lastname: Cronin
authors.forename: Caroline
authors.initials: C
authors.lastname: Savage
authors.forename: Jaspreet S
authors.initials: JS
authors.lastname: Sandhu
authors.forename: John P
authors.initials: JP
authors.lastname: Mulhall
authors.forename: Peter T
authors.initials: PT
authors.lastname: Scardino
authors.forename: Farhang
authors.initials: F
authors.lastname: Rabbani
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000009:adverse effects; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D020127:Recovery of Function; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen