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?
4 responses to “Prostate Size a Limitation for Surgery?”
The largest prostate I removed was 175 grams and it was difficult (3 hrs and 45 minutes and moderate blood loss).
I also did one that was 160 grams that was pictured elsewhere in this blog and it was relatively easy (3hrs and 20 minutes and low blood loss, but he also weighed over 250 pounds or it would have been faster). I think the shape of the prostate and pelvic bone structure has a lot to do with how hard the procedure will be.
Both patients went home the next day and were only wearing 1 pad per day at 1 month and none at 3 months.
One nice thing about surgery is you do not need to take hormone shots and I would agree with Dr. Russell that I would not give patients hormone shots and subject them to side effects and I would rather just do the surgery which should take longer than most, but can be done very safely.
I actually have a patient that wants a robotic prostatectomy that was told by 2 urologists that he was not a candidate for robotics due to the prostate size and he is driving about 300 miles to see me in a week. After discussing his case on the phone, he should be a good candidate for a robotic prostatectomy.
Please tell me, Dr. Savatta, where you are located.
My groups office is in West Orange, NJ. It is about 30 minutes from NYC.
[…] Prostate Size a Limitation for Surgery? – The Robotic … – Aug 19, 2006 · 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.) […]