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Prostate glands larger than 75 cc result in worse outcomes following radical prostatectomy: implications for registrar training
Author(s) -
PATEL M.I.,
CHAN W.,
WOO H.,
LAU H.,
DRUMMOND M.,
BROOKS A.
Publication year - 2006
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2006.06085_56.x
Subject(s) - medicine , prostatectomy , prostate cancer , prostate , urology , surgery , cancer
and Objective: Open radical prostatectomy is a difficult and complex operation to teach residents. Many patient factors can increase the complexity of the operation, with the majority not being predictable prior to the operation. We hypothesised that large prostate glands (>75 cc) would result in increased difficulty, higher intraoperative complications, and subsequently poorer cancer and functional outcomes. Methods: A retrospective analysis of the records of patients in our database of radical prostatectomies performed at Westmead Hospital. Patients operated on by the training urology registrar were identified and further analysed. Intraoperative as well as postoperative complications, pathology results and postoperative gain of potency and continence were evaluated. Results: Between 2/6/1998 to 14/8/04, 181 open radical prostatectomies were performed at Westmead Public Hospital by the training registrar. Preoperative variables revealed that the majority of these patients had large volume cancer (171 pts with cT2 cancer, 70 pts with Gleason Score ≥7). PSA ranged from 1.2–27 ng/ml (median 6.9 ng/ml). Prostate size ranged from 11–112 cc (median 31 cc) measured by TRUS ultrasound. Correlation between calculated TRUS volume and prostate weight at surgery was high ( r = 0.93). Prostate glands greater than 75 cc were associated with older age ( P = 0.001), longer operation time ( P < 0.001)and higher estimated blood loss ( P < 0.001). Postoperatively, prostate glands >75 cc required median of 7 vs 3 months to achieve continence ( P < 0.001). At a median follow time of 45 months, men with prostates <75 cc had a 62% chance of achieving potency compared to 10% of men who has glands >75cc ( P < 0.001). Oncologically, larger prostates had less positive surgical margins ( P = 0.006) and less PSA recurrence ( P = 0.024). Conclusions: Prostates larger than 75 cc result in longer operative times, higher blood loss as well as poorer continence and potency. Patients should be counselled accordingly and trainers should be prepared to supervise more carefully when teaching inexperienced trainees.