Kobe Van Hove*, Louise Callens, Floor Vanelderen, Iraj Ahmadzai, Louis-Philippe Boret, Luca Sarchi, Marco Paciotti, Angelo Mottaran, Adele Piro, Luigi Nocera, Pieter De Backer, Fernando Gonzales-Meza, Ruben De Groote, Alexandre Mottrie and Carlo Andrea Bravi
Background: Radical prostatectomy is among gold standard treatments for prostate cancer (PCa). As compared to other surgical approaches, robot-assisted radical prostatectomy (RARP) offers several advantages such as better intra-operative manipulation and lower peri-operative morbidity and as such, it is currently the preferred surgical option whenever available. In candidates to RARP, a large prostate is often a challenge as it may affect operative and functional outcomes, but can be safely performed according to current literature. However, studies of RARP involving a large prostate were often limited to a weight ranging from 50 to 150 grams, with only few cases of RARP performed on bigger prostate glands. For this reason, we want to describe a case of a patient with a prostate larger than 350 grams treated with RARP at our institution.
Case report: We presented a case of a 68-year-old patient that came for a second opinion following a diagnosis of prostate carcinoma after an elevated PSA of 21 ng/ml without the presence of lower urinary tract symptoms. Magnetic resonance imaging showed a PIRADS 5 lesion in the left apex with an estimated weight of 450 grams. Biopsy showed an International Society of Urological Pathology (ISUP) group-3 adenocarcinoma. RARP was performed using an anterior, trans-peritoneal approach. The operative time was 210 minutes, and the estimated blood loss was 1400 ml. Pathological examination showed a pT3b, ISUP group 3 invasive PCa, with negative surgical margins. After surgery, the patient was discharged after two days without postoperative complications, and the urethral catheter was removed after 5 days. At a follow-up visit 30 days after surgery, the patient had neither voiding problems nor urinary incontinence.
Conclusion: We described a case of a patient with an extremely large prostate who underwent robot-assisted radical prostatectomy for prostate cancer. Our findings suggest that a large prostate size is not an absolute contraindication for RARP, with optimal recovery of urinary continence early after surgery. Further research, especially larger studies with longer follow-up, is awaited in order to accurately evaluate outcomes of RARP in patients with large prostates.
HTML PDFShare this article
Clinical and Medical Case Reports received 53 citations as per Google Scholar report
