Large Prostate more difficult to remove ?

[Maxi54]

In 2013 I had robotic prostatectomy. My prostate was quite large, volume 130ml, size 7.43x5.61x5.97cm. As a result, prostate was removed in two pieces, no seminal vesicles where removed and path: "pT2c bilateral, pNx, GL 4+3 Tertiary 5, EPE not identified, SUV not identified". I understand, pNx means, no lymph nodes removed, but why EPE not identified? and I get this "SUV not identified" because SVs where never removed.

Later I find out it should be open prostatectomy.

My question is if anyone had similar experience

[Still_in_shock]

"EPE not identified" Means they didnt identify anything outside the prostate.

[Still_in_shock in reply to Still_in_shock]

I used to get insulted with "unremarkable", until he told me, nothing there to make remarks.

No J-O-H-N, he wasn't describing my XXXXX😬

[allie2020]

My prostate was measured at 150cc from mpMRI and then 150g after my robotic prostatectomy in 2018. Mine came out in one piece. I interviewed five surgeons and chose the one I felt most comfortable with. I asked him if it was difficult because of the size. He just shrugged and said it barely fit on the tray to remove it from my body. I had no lymph nodes removed.

[Still_in_shock in reply to allie2020]

Tray? Mine was put in a plastic bag, and pulled out of the incision above my navel. They opened the incision to get it out.

[Maxi54 in reply to allie2020]

Mine surgeon had large number of procedures under his belt but there was another young surgeon assisting during operation. I knew that before my surgery so I specifically ask who will do it. I was assured that my primary surgeon will do it. Removing prostate in pieces?- seems unusual . Right after operation surgeon told my wife the operation was difficult because "prostate was pushing on the bladder"

[MNFarmBoy]

The pathology report from my RP (Dec. 2018) includes the following similar verbiage:

"Location of Extraprostatic Extension: Le􀀁 bladder neck

Urinary Bladder Neck Invasion: Present

Seminal Vesicle Invasion: Not identified"

I interpret the "Not identified" as meaning "appears to not be present". I understand that they assessed the "Urinary Bladder Neck Invasion: Present" from examining the incision area of part of the bladder neck that was removed along with the prostate, and similar for the incision area of the parts of the prostate that connected the prostate to the seminal vesicles.

When I have questions about issues like this, I ask the doctor for explanation, usually via the "My Chart" web-based info service that they use.

The urologist indicated that my prostate was somewhat swollen (maybe borderline too soon after biopsy), but the pathology report indicates "Prostate Weight (g): 53.2 g". Assuming that the density was slightly greater than that of water, that would mean a volume of <53 cm^3, thus only ~40% the size quoted in the original post for this thread, so I have no relevant experience in that regard.

Fortunately my PSA has remained below the limit of detection (<0.014 ng/ml) for 5+ years despite small extraprostatic extensions and small positive margins.

Best wishes for the best possible outcome!

[Maxi54 in reply to MNFarmBoy]

5+ years with low PSA looks good. Congratulations.

As I mentioned before my prostate originally was 130ml.My Uro surgeon start HT before RALP (four shots of Firmagon every month) in case to "shrink prostate", so after procedure prostate weighted 53g.I guess not removing SVs was later problem because within six months PSA went up and MRI show left SV had a 7mm nodule suspicious for cancer recurrence.

[j-o-h-n]

Was I lucky or wasn't I? Mine was removed the old fashioned way (2002) and two hernias were repaired at the same time..... You know the saying "size is everything"...

Good Luck, Good Health and Humor.

j-o-h-n