I recently saw a patient who had been biopsied by another urologist, found to have cancer and sent to a second urologist for evaluation for surgery. That second urologist does not do robotic prostatectomies and did not mention the option. He was also put off by the size of the prostate as estimated by ultrasound at the time of biopsy, 172 cc’s. (A normal prostate in a man in his 20s might measure 25 cc’s +/- and a volume of 50-100 cc’s is not uncommon in men in the age range of 50-70 that constitute the majority of cancer patients being considered for radical surgery.) The second urologist recommended open surgery, but only after at least 4 months treatment with hormone deprivation (blocking the production of testosterone) to shrink the prostate. He gave him a shot to accomplish reduction (leuprolide) and planned to see him back in 4 months. The patient is now experiencing the side effects of the shot, hot flashes and progressive erectile dysfunction, while he waits for his surgery. Is this necessary?
My partner and I have removed prostates roboticly as large as 167 grams (1 gram in weight is approximately equal to 1 cc in volume) and Dr. Savatta I know has had similar experience. The larger prostates are somewhat more challenging but I think the procedure, done roboticly, is easier with large prostates than it is open. But then I think that radical prostatectomy done roboticly is overall an easier, better operation than open. I suppose there is an upper limit of what is possible to remove safely by any approach. I am reminded of my patient with a prostate that measured more than 450 cc’s by ultrasound. Fortunately he does not have cancer as far as I can tell, so radical surgery never became an issue but I would hesitate to recommend surgery in his case.
If you are a patient with prostate cancer and you are told it is too large for surgery or that you have to undergo hormone treatment for months to reduce the size, please consider getting a another opinion from a surgeon with experience in robotics. It can be done and it can be done well with the da Vinci.
Perhaps Dr. Savatta or Dr. Yew have some comments on the subject?