Extremely Large prostate with localised cancer

Can you give some more information about your diagnosis - this will help us all to help you. Has your case been discussed by the multi-disciplinary team who have recommended surgery or are you just thinking at the moment that this might be your preference? The size of your prostate may have ruled out options such as brachytherapy but it would be helpful to know whether radiotherapy was considered?

If you are having surgery, the useful things to clarify would be:

- as the prostate is so large, would the op still be keyhole / robotic or are they recommending open surgery?

- will the op be nerve sparing or non-nerve sparing?

- have they discussed with you the impact that removal of such a large prostate might have on the length of your penis afterwards? Of course, your 170cc prostate may be very wide but no longer than usual but on average you lose the same penis length as the length of the prostate gland.

I'm doubting this. Yes, you normally lose some length, but

a) the bladder neck and urethra are pulled together to meet, so the bladder moves too, not just all done by pulling urethra in, and

b) large prostates tend to grow up pushing into the bottom of the bladder (they can't grow down - pelvic floor is in the way). This was very clear on my cystoscopy, where when we looked around inside my bladder, there was a large inward dent at the bottom where my 94cc prostate was pushing in to it, and the urologist noted that, saying I had a large prostate (exact size wasn't known at that point).

I doubt the penis length lost directly maps to the length of the prostatic urethra.

Edited by member 14 Sep 2020 at 10:44  | Reason: Not specified

I had my Retzius sparing RARP and Neurosafe done by the Prof Whocannotbenamedonhere. Worth searching for Santis in google.

high volume surgeon is a good place to start.>100 procedures per year.

i had expected a shortening but in my case didn’t see any change. The urethra is quite elastic and adapts plus the bladder it pulled down to reconnect so hopefully will be much the case with you too.

neurosafe is being reviewed by NICE I think. Not due on the NHS for ~5yrs. Definitely worth having as gives the surgeon extra visibility during the op. My frozen sections taking in real time showed some focal involvement so they took more tissue. However, I was fortunate as the paraffin staining with histology showed them to all be in fact clear.

my biopsy was 3+3 but the Prof rightly predicted as upgrade from histology - 3+4. I had tumour in all four quadrants of the prostate. The timing of the surgery was right on the nose as had I left it much longer would have almost certainly breached the capsule.

Edited by member 14 Sep 2020 at 16:00  | Reason: Not specified