title: Does size matter? The significance of prostate size on pathologic and functional outcomes in patients undergoing robotic prostatectomy.
abstract: BACKGROUND
  We examined the effect of prostate weight on perioperative data, and the pathological and functional outcomes of robotic-assisted laparoscopic prostatectomy (RALP).
  
  
  METHODS
  Data were available from 716 consecutive patients before, during and after undergoing RALP at one institution. Prostate size was arbitrarily stratified by recorded prostate weight into <50, 50-80 and >80 g, corresponding to small, moderate and large glands, respectively. Perioperative data and the histopathological and functional outcomes were compared across these groups by both univariable and multivariable-adjusted analyses.
  
  
  RESULTS
  Increased prostate size was associated with increased age, preoperative prostate-specific antigen levels, body mass index, operative duration, blood loss, lower biopsy and pathological Gleason scores, and lower pathological staging (P < 0.05). The incidence of extensive positive surgical margins was 14.8%, 9.7%, and 5.3% in small, moderate and large prostates, respectively (P < 0.001). However, after multivariable adjustment, only Gleason score and pathological stage were significantly associated with the incidence of positive margins (P < 0.05); prostate weight was not significantly associated. Overall, 78% and 92% of patients were potent and continent at 12 months, respectively, which was not affected by prostate size.
  
  
  CONCLUSIONS
  Patients with larger prostates had favourable pathological outcomes after RALP. When controlling for pathological stage, prostate size was not associated with margin positivity. Functionally, neither continence nor potency at 12 months was affected by prostate size.
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY, USA.
authors.forename: Carl A
authors.initials: CA
authors.lastname: Olsson
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Hugh J
authors.initials: HJ
authors.lastname: Lavery
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Dov
authors.initials: D
authors.lastname: Sebrow
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Ardavan
authors.initials: A
authors.lastname: Akhavan
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Adam W
authors.initials: AW
authors.lastname: Levinson
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Brajtbord
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, New York, NY, USA.
authors.forename: John
authors.initials: J
authors.lastname: Carlucci
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.affiliation: Department of Urology, The Mount Sinai Medical Center, New York, NY, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Samadi
keywords: BMI, body mass index; Continence; EBL, estimated blood loss; LOS, length of hospital stay; Margins; OR, operating-room; Outcomes; PSM, positive surgical margin; Potency; Prostate cancer; Prostatectomy; RALP, robotic-assisted laparoscopic prostatectomy; Robotic surgery; SHIM, sexual health inventory for men