A large prostate at radical retropubic prostatectomy does not adversely affect cancer control, continence or potency rates

To determine the effect of a large prostate at radical retropubic prostatectomy (RRP) on the pathological outcome, biochemical recurrence rates, potency and continence. 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 less than or equal to 75 g were compared. 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. 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.