Impact of Prostate Size on the Outcomes of Radical Prostatectomy: A Systematic Review and Meta-Analysis

Background: The impact of prostate size on the radical prostatectomy outcome is not clear. Several published reports have shown conflicting results. Objectives: To investigate the effect of prostate size on the surgical, functional and oncological results of radical prostatectomy. Methods: A systematic review and meta-analysis were carried out in accordance with the PRISMA criteria. Finally, we investigated the research that reported on the impact of prostate size on radical prostatectomy outcome. The Review Manager (RevMan) software version 5.4 was utilized for statistical analysis. Results: Eighteen studies including 12,242 patients were included. Estimated blood loss was significantly less with smaller prostates (Z = 3.01; p = 0.003). The complications rate was 17% with larger prostates, compared to 10% for smaller prostates (Z = 5.73; p < 0.00001). Seventy-three percent of patients with a smaller prostate were continent within one month, compared to 64% with a larger prostate (Z = 1.59; p = 0.11). The rate of positive surgical margins was significantly higher with smaller prostates (20.2% vs. 17.8%). (Z = 2.52; p = 0.01). The incidence of biochemical recurrence was higher with smaller prostates (7.8% vs. 4.9%) (Z = 1.87; p = 0.06). Conclusion: Larger prostate size is associated with more blood loss and a higher rate of complications. However, the oncological outcome is better, compared to that in patients with smaller prostates. The impact of the size on the functional outcome is not clear.

Holmium Laser Enucleation of the Prostate Efficiency by Prostate Gland Size: Is There a Sweet Spot?

Holmium laser enucleation of the prostate (HoLEP) is one of only two AUA guideline-recommended prostate size-independent surgeries for benign prostate hyperplasia (BPH). The significant variation in gland size treated results in a wide range of enucleation and morcellation times. We sought to understand the effect of prostate size on HoLEP efficiency to better educate patients and improve operative room utilization. After IRB approval, we identified patients from 1 July 2016 to 1 January 2020 who underwent HoLEP by two endourologists. Our primary objectives were to assess the effects of increasing increments (25 g) of mean enucleated prostate tissue weight on enucleation and morcellation efficiency (g/min). One-way Kruskal–Wallis ANOVA with Dunn’s post hoc test was used, with significant p < 0.05. We included 675 HoLEPs with all comers mean tissue weight resected of 72.1 g (Range 1–448 g), energy used 110.00 kJ (10.73–340 kJ), enucleation time 48.6 min (5–151 min), and morcellation time 10.1 min (0.5–113 min). Average enucleation efficiency increased with increasing prostate size categories (e.g., <25 g–0.48 g/min, >325 g–3.91 g/min) (K-W ANOVA p = 0.004, Dunn’s post hoc p = 0.004). The combined average enucleation and morcellation efficiency was ≥5 g/min between 55 and 271 g. Inefficiency for cases <55 g was driven by enucleation, while >271 g case inefficiency was driven by morcellation. Increasing tissue weight at the time of HoLEP is associated with a linear relationship of increasing enucleation and decreasing morcellation efficiencies.

Ultrasonographic study of comparison of prostate volume and post void residual urine with age in north Indian population

Background: As men’s life expectancy increases, benign prostatic hyperplasia (BPH) is the significant cause of morbidity. BPH generally involves the central region of the prostate which gradually enlarges. Due to the central hypertrophic change of prostate the urethra is compressed and urinary outflow obstruction develops. Predictive risk factors associated with chance of developing urinary retention includes age, symptoms, urinary flow rate and prostate size. Estimation of accurate intravesical, residual urine has significant importance and serves as an index of adequacy of bladder emptying. Aims and Objectives: The study aimed to measure the post void residual urine volume with age in Prostate outflow obstruction and compare the prostate volume and post void residual urine with age by ultrasonography. Materials and Methods: The present study was performed in 100 patients. Transrectal ultrasonography was performed using 7.5 MHZ transrectal probe. Prostate volume was calculated with the help of inbuilt software, by measuring 3 dimensions of prostate in transverse and longitudinal sections. Transabdominal suprapubic ultrasound was done to measure post void residual urine. Results: It was seen that in the lower age groups, the prostate size was smaller, while in the higher age group it was higher (p>0.001). Minimum post void residual urine was seen in age group of 40-49 years (3.42 -+2.23ml). while maximum mean value was seen in the 70-79 years of age. Statistically a significant difference in mean was seen among different age groups (p<0.001). Conclusion: There is a significant correlation between age and post void residual urine volume and prostatic volume. The present study showed that PVRUV is a novel accurate non-invasive test for predicting prostate biopsyoutcome that can easily be used by clinicians, alone or in combination with Prostate Volume in the decision-making for treatment.

Safety profile of GreenLight XPS laser photoselective vaporisation of the prostate in patients at high risk of bleeding

Objective: This study aimed to assess the utility and safety profile of the GreenLight Xcelerated Performance System (XPS) photoselective vaporisation of the prostate (PVP) to treat benign prostatic hyperplasia (BPH) in high-risk patients. Patients and methods: A retrospective study of a prospectively managed database was carried out. The study reviewed a single surgeon’s experience of treating high-risk patients with GreenLight XPS PVP between two sites over a four-year period. Patients considered to be high risk were those who were at an increased risk of bleeding, those who had a prostate size >80 mL, those with preoperative urinary retention and/or those aged >80 years. Results: In total, 374 patients were identified as being high risk for GreenLight PVP. Patient age ranged from 44 to 96 years ( Mage=71 years). Of the 374 patients, 103 were aged >80 years. All 374 patients were considered to be at an increased risk of bleeding, as they underwent GreenLight PVP while taking antiplatelet agents (not including aspirin), anticoagulant agents or both. Ninety-one patients had preoperative urinary retention and indwelling urinary catheter. Fifty-four patients had a prostate size >80 mL. Length of stay varied from 1 to 14 days. Most patients ( n=270) were discharged on postoperative day 1. There were no perioperative blood transfusions. One patient developed acute coronary syndrome on postoperative day 4, requiring percutaneous coronary intervention. Twenty-two patients required readmission: 12 due to urinary retention with or without haematuria, and 10 due to haematuria without associated acute retention. Two patients required cystoscopy and bladder washout. There were two blood transfusions in the ‘readmission due to haematuria’ group. Outcomes for patients aged >80 years were favourable. The average length of stay was 2.7 days (range 1–14 days). This group was responsible for 12 of the 22 readmissions. There were no perioperative cardiovascular events. Conclusion: We conclude that GreenLight XPS PVP is a safe procedure in patients with one or more high-risk factors. The ability to proceed without the need to stop antiplatelets or anticoagulant agents also allows for high-risk medical patients to be treated without the additional risks of cardiovascular events. Level of evidence: Not applicable for this multicentre audit.

Basic factors predicting prostate cancer in Prostate Imaging Reporting and Data System-3 lesions

Objective: We aimed to investigate the role of the digital rectal examination, PSA density, regional location of the lesion and prostate size in predicting prostate cancer in Prostate Imaging and Data Reporting System (PI-RADS)-3 lesions. Material and Methods: A total of 236 patients with multiparametric MRI performed for clinical suspicion of prostate cancer and reported PI-RADS-3 enrolled between January 2016 and July 2019 in this retrospective study. The datas were extracted from the hospital’s electronic records, patient files and outpatient clinic records. Multiparametric MRI was performed patients to whom have elevated PSA level and/or suspicious digital rectal examination. Patients diagnosed with and without prostate cancer were compared in terms of age, PSA, PSA density, prostate size, pathological results, lesion localization and DRE findings. Results: One hundred thirty- independent predictor seven patients with an initial score of PI-RADS-3 were subjected to further analysis. Prostat cancer detection rate in overall and clinically significant prostate cancer detection rate was 26.2% and 4.3%, respectively. There was a significant difference regarding DRE findings (p=0.001) and PZ location of the lesion (p=0.005) between PCa and no PCa groups. Digital rectal examination (p=0.001) was an independent predictor of prostate cancer in multivariate logistic regression analysis. Conclusion: Digital rectal examination is a practical and important parameter in clarifying the suspicion of prostate cancer in PI-RADS-3 lesions. Keywords: prostatic neoplasms, digital rectal examination, multiparametric magnetic resonance imaging, image guided biopsy

Finasteride Reduces Total Cholesterol in LDLR-Deficient Mice

Objectives Androgen imbalance is associated with cardiovascular disease risk but the exact impact on lipid and glucose profile is unknown. Finasteride (FIN) prevents the conversion of testosterone to its active metabolite dihydrotestosterone (DHT) by inhibiting the type II 5alpha-reductase. Our objective is to examine the impact of FIN on cardiovascular disease risk. We hypothesize that FIN delays the progression of atherosclerosis by ameliorating hyperglycemia and dyslipidemia. Methods We used the low-density lipoprotein receptor (LDLR)-deficient (Ldlr−/−) mouse model as a widely regarded model of atherosclerotic plaque development in rodents. Four-week-old male mice (n = 9–15/group) were fed a Western-diet containing 41% fat +0.3% cholesterol with increasing doses of FIN (10 mg/kg, 100 mg/kg, and 1000 mg/kg diet) for 12 weeks. Littermates fed Western-diet without FIN were used as a control group. A week before tissue harvest, mice were subjected to a glucose tolerance test (GTT). At the end of the experiment, mice were sacrificed, and their tissue and body weights were analyzed. A total cholesterol assay was performed at 0, 4, 8, and 12 weeks. Results We examined prostate size, whose growth is DHT dependent, as an indicator of the effect of finasteride in our experimental model. We observed a dose-dependent effect of FIN on prostate size for all the doses (P &lt; .0001), indicating FIN had a physiological impact on these mice. No changes in food intake or circulating transaminase levels were observed, discarding any evidence of food intolerability or hepatic toxicity. FIN did not alter GTT among experimental groups or any other biometric parameter. However, we observed a significant reduction in body weight gain in the high dose group (P = .0027) in comparison to the other experimental groups. Total cholesterol levels at the time of the sacrifice were significantly reduced in the high dose group (P &lt; .0001) in comparison to the other experimental groups. Future experiments will include atherosclerotic plaque characterization of both size and composition. Conclusions Our findings suggest that a high dose of FIN is associated with a reduction of total plasma cholesterol and body weight in Ldlr−/− mice. Funding Sources USDA multistate hatch project (W4002)