Prostate cancer and benign prostatic enlargement are both common in older men, so they often occur together. Some men with prostate cancer have a very large prostate. Others have already had treatment for an enlarged prostate, such as TURP or laser surgery. In both situations, robotic prostatectomy is usually still possible, but it can be more complex.
Why a large prostate matters
A large prostate can make surgery more challenging because:
- there is less working space in the pelvis
- the junction with the bladder can be wider, making the join between the bladder and urethra more complex
- a large middle lobe can project into the bladder, close to the openings of the ureters, which carry urine from the kidneys
- the operation may take longer
Despite this, experienced robotic surgeons regularly operate on large prostates. The magnified view and precise instruments help in these situations.
Planning for a large prostate
Before surgery, the team will look closely at your MRI to measure the prostate and assess any middle lobe. Our article on how MRI helps plan your prostatectomy explains what the scan shows. This helps the surgeon plan how to separate the prostate from the bladder and protect the ureters.
Recovery with a large prostate
Recovery is generally similar to that after standard robotic prostatectomy. Some men with a large prostate notice that their urinary flow is much better after surgery, as the cause of blockage has been removed along with the cancer. Continence recovery can sometimes be a little slower, and the catheter may occasionally be left in for a few extra days to allow the wider join to heal. Pelvic floor exercises are especially helpful.
Surgery after TURP or other BPH procedures
Treatments for an enlarged prostate change the tissue inside the gland:
- TURP and laser surgery: remove tissue from the centre of the prostate, which can leave scarring around the bladder neck. Our guide to TURP explains the procedure.
- Aquablation: uses a waterjet to remove tissue. Our Aquablation page explains the treatment.
- Implants or temporary devices: such as UroLift or iTind. Permanent implants may need to be removed or worked around during surgery.
- Prostate artery embolisation: reduces blood supply to the gland, which may cause some scarring around it.
How previous treatment affects surgery
Previous BPH treatment can:
- make the bladder neck harder to identify and reconstruct
- cause scar tissue that makes dissection more difficult
- slightly increase the risk of leakage after surgery
- in some cases, affect the ability to spare the nerves
Despite these challenges, robotic prostatectomy after BPH surgery is generally safe and effective in experienced hands. Cancer outcomes are usually similar to those in men without previous treatment.
Timing after BPH treatment
If prostate cancer is found after TURP or another procedure, surgeons often wait several weeks before a prostatectomy. This allows inflammation to settle and makes the operation safer. Your team will advise on the right interval in your case.
Other treatment options
For some men, radiotherapy or active surveillance may be more suitable. Radiotherapy after TURP can sometimes increase urinary side effects, so the choice needs careful discussion. NICE guidance on prostate cancer sets out the options.
Questions to ask
- How large is my prostate, and does that change the operation?
- How might my previous BPH treatment affect surgery?
- What continence recovery should I expect?
- Are other treatments more suitable for me?
Prostate Cancer UK has information on treatment choices.
Professor Prokar Dasgupta operates on men with large prostates and after previous BPH treatment at The London Clinic. Our page on expert robotic surgery explains his approach. Please contact the clinic to arrange a consultation.