IMPACT OF PROSTATE SIZE ON THE OUTCOMES OF RADICAL PROSTATECTOMY

• Published in: Urologic oncology 2024-03, Vol.42, p.S97-S97
• Main Authors: Deol, Ekamjit Singh, Lehner, Kelly S, Fadel, Anthony E, Rangel, Laureano J, Khanna, Abhinav, Tollefson, Matthew K, Shah, Paras H, Frank, Igor, Boorjian, Stephen A, Karnes, Robert J, Sharma, Vidit
• Format: Article
• Language: English
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2024.01.270

Prostate size exhibits considerable variation among men. Recent evidence from computational, pathologic, and radiologic studies has suggested that enlarged prostates may confer protection against the development of aggressive prostate cancer. In theory, small prostates provide a relatively androgen resistant milieu compared to large prostates, and cancers that develop in smaller glands may be more likely to be androgen resistant and thus aggressive. Nonetheless, the relationship between prostate size and perioperative and oncological outcomes remains uncertain. To address this gap, we studied the association between pathologic prostate specimen weight and perioperative and long-term oncologic outcomes after radical prostatectomy. This study queried the Mayo Clinic's prospectively maintained prostatectomy registry from 1986 to 2017. This study included patients with non-metastatic pathologically confirmed prostate adenocarcinoma and excluded patients that had undergone prior BPH therapy or had previously been taking androgen deprivation therapy. Prostate size was determined using pathologic specimen weight. Prostate sizes were grouped into multiples of 25gm. Multivariable cox analysis evaluated biochemical recurrence after controlling for age, PSA, grade, stage, surgical year, surgical approach, and adjuvant therapy. Using 0-25gm prostates as the reference group, several multivariable logistic regressions were conducted to assess the odds of positive surgical margins, incontinence, and erectile dysfunction at the one-year postoperative mark. In a cohort of 19,160 patients undergoing radical prostatectomy, most patients had prostates between 0-50gm (81%), while 13.6%, 3.44%, and 1.80% had prostate sizes of 50-75gm, 75-100gm, and 101+gm, respectively. Patients with larger prostates had higher PSAs and had a lower incidence of positive surgical margins (Table 1). They also had a lower incidence of complete nerve sparing, post-operative potency without medications at 1-year, and post-operative continence at 1-year. On multivariable regression analysis (Figure 1), increasing prostate size was associated with lower risk of positive margins, reduced biochemical recurrence and increased risk of incontinence at 1-year. However, the risk of post-operative impotence at 1-year did not significantly vary by prostate size. Larger prostates had a lower risk of positive surgical margins, and despite adjusting for margin status and other pathological variables, they were as