The effect of prostate weight on the outcomes of laparoscopic radical prostatectomy

To evaluate the effect of prostate weight on perioperative, functional and oncological outcomes after laparoscopic radical prostatectomy (LRP). Between January 2003 and January 2006, 327 patients had LRP by one surgeon, 193 of whom were available for analysis. Patients were stratified into three groups on the basis of pathological prostate weight, i.e. <= 30, 30-75 and >= 75 g. Perioperative, oncological and functional (continence and potency at 1 year) outcomes were compared among the three groups. Of the 193 patients the prostate was <= 30 g in 18 (9%), 30-75 g in 131 (68%) and >= 75 g in 44 (23%); the mean prostate weight was 27, 49 and 98 g in the three subgroups, respectively. At presentation, 144 patients (75%) had T1c disease, 159 (82%) were potent and 187 (97%) were continent. Unilateral nerve-sparing was done in 37 (19%) and bilateral in 114 (59%) patients. The three subgroups were comparable in age, body mass index, preoperative prostate-specific antigen level, preoperative Gleason score, clinical stage, operative duration, length of hospital stay, duration of catheterization, biochemical recurrence and continence after LRP. In the patients with a prostate of <= 30 g there was a higher incidence of positive margins (39% vs 16% vs 27%; P = 0.03) and inferior 1-year potency (47% vs 75% vs 79%; P =0.04), respectively. Estimated blood loss increased with increasing prostate size (204 vs 256 vs 340 mL; P = 0.01). Prostate size has no effect on continence or biochemical recurrence at 1 year after LRP, but affects intraoperative blood loss, potency and surgical margins. More patients with a longer follow-up are needed to confirm these findings.