Large Prostate Solutions: Treatment Options

When your prostate weighs 100, 150, or even 200+ grams, you've outgrown the "typical" treatment options. But large gland size doesn't mean limited solutions—it means specialized solutions. Here's what works for truly massive prostates.

Calculate your weight using our Prostate Weight Calculator.

Defining "Large"

Size categorizations vary, but generally:

• Large: 80-100g (approaching specialty procedures)
• Very Large: 100-150g (specialized center recommended)
• Massive: >150g (expert surgical center required)

For comparison, a normal prostate is 20-25g (walnut). A 200g prostate is the size of a grapefruit or larger.

Why Standard TURP Doesn't Work

Traditional TURP is not ideal for very large prostates because:

• Time limitations: Resecting 100g+ takes >90 minutes (TUR syndrome risk)
• Blood loss: Scales linearly with tissue volume
• Incomplete resection: Often can't remove all obstructing tissue
• Staged procedures: May require returning for second surgery

Learn more in our TURP vs HoLEP comparison.

Treatment Options for Large Prostates

1. HoLEP (Holmium Laser Enucleation)

The champion of large glands. HoLEP can handle any size:

• 100g prostates: ~90 minutes
• 200g prostates: ~120 minutes
• 300g+ prostates: Documented successful cases

Benefits:

• Size-independent efficiency
• Lower blood loss than open surgery
• Transurethral (no abdominal incision)
• Near-complete adenoma removal
• Durable results (1-2% retreatment at 5 years)

Limitations:

• Steep learning curve (40-50 cases to proficiency)
• Available only at specialized centers

2. ThuLEP (Thulium Laser Enucleation)

Similar to HoLEP but uses thulium laser:

• Comparable outcomes to HoLEP
• Some surgeons prefer the cutting characteristics
• Also handles any size

3. Simple Prostatectomy

Removal of the prostate adenoma through an incision:

Open Simple Prostatectomy

• Traditional approach through lower abdominal incision
• Excellent for >80-100g prostates
• More invasive (larger incision, longer recovery)
• Well-established with predictable outcomes

Robotic Simple Prostatectomy

• Same procedure via robotic-assisted laparoscopy
• Smaller incisions, potentially less blood loss
• Shorter hospital stay than open
• Increasingly performed at academic centers

4. Bipolar TURP (B-TURP)

Newer TURP technology that:

• Uses saline irrigation (eliminates TUR syndrome)
• Allows longer resection times
• Extends TURP feasibility to larger glands

Still limited by resection speed and blood loss, but can handle 80-100g reasonably.

Medication: Can It Shrink a Large Prostate?

5-Alpha Reductase Inhibitors

Finasteride and dutasteride can shrink prostates by 20-30%:

• 150g → ~105-120g over 6-12 months
• May reduce symptoms enough to avoid surgery (for some)
• Often used pre-operatively to reduce surgical difficulty

Combination Therapy

Alpha-blockers + 5-ARIs together provide:

• Quick symptom relief (alpha-blocker)
• Long-term shrinkage (5-ARI)
• Best for men who want to delay/avoid surgery

What Doesn't Work for Large Prostates

• UroLift: Not FDA approved >80cc
• Rezum: Not approved >80cc
• Standard TURP: Impractical >80-100g

Choosing the Right Center

For very large prostates, expertise matters:

1. Ask how many large gland cases the surgeon has done
2. Look for academic medical centers with HoLEP programs
3. Consider traveling for specialized care if needed
4. Verify outcomes data (complication rates, retreatment)

Key Takeaways

Calculate your prostate weight with our Weight Calculator to determine which category you fall into.