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Does size matter?

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Posted 10/4/2010 11:19 AM (GMT -5)
I'm still in the process of interviewing surgeons for a RRP (probably with da Vinci robot). One of my concerns re: laparoscopic surgery is that my prostate seems to be much bigger than average. (From the ultrasound used during biopsy my URO estimates my prostate is 88cc---about twice the average size.) So I assumed RRP was going to be more difficult, especially for laparoscopic methods.

But one of the surgeons told me just the opposite; he said it's actually easier because the nerves are more visible on a larger prostate. He said the only issue with a large prostate is when the patient has a small frame. (I don't---6'3", 220 lb.)

I have no reason to doubt this surgeon, but has anyone heard a similar comment from a surgeon? I am just trying to make sure I'm a good candidate for the laparoscopic (da Vinci) surgery.

Thanks,

88CC
Posted 10/4/2010 4:41 PM (GMT 0)
88CC,

If any surgeon finds that while doing robotic he/she needs to switch mid operation to an open they will do that
Posted 10/4/2010 12:56 PM (GMT -5)
88
My surgeon has told me something quite opposite. I'm 6'3" and 260# with a 78. He told me that I might have a smaller area to work in because of larger bone structure or somethng like that. Although he did say that Lap would be no problem.
I'm still waiting for a surgury date.
Mike
Posted 10/4/2010 3:37 PM (GMT -5)
I   had a 70 (+) gram prostate removed via daVinci 17 months ago.  It came out with no problems.

Just as Gimpy explained, my surgeon explained to me that he would switch to open surgery if he had problems with the Davinci.  Besides the large prostate the surgeon also had to work around a "mesh" I had installed for a hernia repair ... he was able to work under it.

Good luck and best wishes.

Posted 10/4/2010 9:05 PM (GMT -5)
I had robotic and my was 5.4cm x 4.2cm x 3.8cm, not exactly small. He also took out 4 lymph nodes for examination. Some write-up said robotic had difficulty taking out lymph nodes.
Posted 10/4/2010 9:21 PM (GMT -5)
I had a 60 removed and i thought that was big, there was a bigest prostate contest here on this site a few months back and well.... turns out there were some over 100. So, 60 or 80 is big compared to average(my uro said 20) but some were twice as big as mine. Don't worry it aint that big.
Posted 10/5/2010 5:34 AM (GMT -5)
Someone else and myself are tied for first place, if I may modestly say.  110 at removal.  One thing to remember is the size at ultrasound biopsy is just an estimate, actually.  Mine was measured at 76 at biopsy and was much bigger when actually lying in the pan.
Posted 10/5/2010 5:58 AM (GMT -5)
Ultrasound at biopsy usually only measured the dimensions of the gland ie 5x4x5 and fropm that they calculate/estimate a volume, and as 1cc of "flesh" weighs about 1gm it is usually okay to reckon that a 50cc gland will weigh 50gm.
After surgery everything that has been removed will get weighed thus final weight may include seminal vesicles etc, it may thus not be possible to say what the weight of just the prostate was unless it has been dissected and weighed separately.

The only concern I have heard about size during a da vinci relates to the "apparatus" used to pull the detached gland out of the body. The gland gets lifted from it's original position into a sort of bag on the end of one of the arms and that then gets pulled out of the large hole by the navel. Clearly the gland has to fit in the bag and the hole has to be made big enough to remove it.

As I understand small medium and large are okay and that it is only if a gland is massive that perhaps hormones can be given before surgery to shrink it, but this can then make it harder to work out the pathology afterwards.


Alf
Posted 10/5/2010 6:04 AM (GMT -5)
Exactly, Alf. The size of the opening will be determined by the size of the bag.  My surgeon said if we had gone with robotic, he would most likely have switched to opne as soon as he saw what he was removing.  Using hormone to shrink it wasn't mentioned before hand, but probably wouldn't have worked, who knows.  The size at biopsy was why we went with an open, as the opening are really about the same, as far as actual length, just one is all in one place and the other is strewn about over the abdomen.  The size is also the reason I wasn't able to do the seeding. 
Posted 10/5/2010 6:08 AM (GMT -5)
Here's the description from my path report:

110 grams, 2.2"x2.2"x1.75" size, I'm guessing the size is the gland itself, and the grams is the weight of the total, maybe? Or maybe not, they may have weighed it seperate when measuring it, no one knows now, anyway.

Posted 10/5/2010 6:15 AM (GMT -5)
And remember your Math. An 88gm prostate is twice the weight of a 44 gm gland but not twice the size.
Volume (and mass) are proportional to the cube of the radius, ie

a 3.5x3.5x3.5 cube is about 43cc, but a 7x7x7 one is 343cc. A 4.5x4.5x4.5 cube is about 91cc, so a gland of 88gm will actually only be about ONE centimetre bigger than a 44gm one.

Alf

Post Edited (English Alf) : 10/5/2010 7:45:20 AM (GMT-6)

Posted 10/5/2010 7:52 AM (GMT -5)
just make sure you have a surgeon who is highly skilled in all surgeries - Davinci, Laproscopic, open. Many of the younger hotshots have tons of experience with Davinci, but only done a few opens or laps. As you know, it's not as simple as just the number of surgeries he has done. I liked the fact that my surgeon could switch to any method if anything happened - from mechanical failure, power failure, or heart failure!
Paul
Posted 10/5/2010 1:20 PM (GMT -5)
Thank you all for your comments. I guess I'm not going to worry about this; if I pick the right surgeon, he'll know what to do. In the mean time, my wife found this article:

http://www.pcf.org/site/c.leJRIROrEpH/b.5801087/k.EFBC/Prostate_Size_Does_Not_Affect_Results_of_Surgery.htm

In summary, even though a larger prostate may be a more difficult surgery, the outcomes are similar across all weight/volumes.

Thanks again guys. (I'll let you know what the final pathology report says.)

Cheers,

88CC
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