Prostate size: Not all prostates are created equally

A normal sized prostate is roughly the size of a walnut. This weights about 20-30 grams. Prostates all have different sizes and shapes. This has important implications for patients with benign prostate problems, as well as patients with cancer. It has an impact on the side effects expected with radiation, the need for hormones prior to certain therapies, as well as the difficulty in removing a prostate.


My robotic prostatectomy series has allowed me to remove prostates ranging in size from 22 grams to 185 grams.
The important implication of prostate size is as follows:
For BPH (benign prostate problems)- larger prostates are more likely to lead to urinary trouble, not being able to urinate (urinary retention), and needing surgery.
If your prostate is very large, over 100 gms, then office therapies and laser ablative therapies are more likely to fail long term. I like performing a robotic simple prostatectomy in this setting.
For Cancer:
If you are thinking of seed placement, cryosurgery (freezing the prostate), or HIFU (using ultrasound to heat the prostate), and your prostate is over 50 gms, you will likely need hormonal therapy to shrink the prostate.
Several studies report higher urinary problems with brachytherapy (seed placements) if the prostate is greater than 50 gms.
Men that have surgery with large prostates typically have improved urination when they are recovered from surgery, compared to before the operation. The surgery treats the cancer, but also removes the benign part of the prostate.
Technically robotic prostatectomy is more difficult to perform with a large prostate. In my experience:
The easiest is when the prostate is less than 40 gms.
Prostates from 40-80 gms are sometimes more challenging, sometimes not much harder, but take longer to remove (15 minutes).
Prostates 80-120 gms are harder still and usually take considerably longer (30-60 minutes). You are

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