Skip to main content

Prostatectomy for Prostate Cancer

Prostatectomy is a surgery that removes the prostate gland. Prostatectomy also removes some tissue around the prostate and may remove nearby lymph nodes if the cancer has spread there. Prostatectomy is done to treat prostate cancer that is localized (confined to the prostate) or locally advanced (spread to nearby tissues). There are different ways to perform prostatectomy, depending on the surgeon's preference, the patient's condition, and the availability of equipment. The main types of prostatectomy are: open radical prostatectomy, laparoscopic radical prostatectomy, and robotic-assisted radical prostatectomy.

Radical Prostatectomy.
Prostatectomy is a surgery that removes the prostate gland. Source.

What is open radical prostatectomy?

Open radical prostatectomy is a surgical procedure for treating prostate cancer, where the entire prostate gland and some surrounding tissues are removed through an incision. This traditional method can be performed with either a retropubic incision (in the lower abdomen) or a perineal incision (in the space between the anus and scrotum). It offers direct access to the prostate, allowing the surgeon to feel the gland and surrounding tissues, which can be beneficial in certain cases. Recovery may involve a longer hospital stay compared to less invasive methods.

What is laparoscopic radical prostatectomy?

Laparoscopic radical prostatectomy is a minimally invasive surgical technique used to remove the prostate gland in prostate cancer patients. In this procedure, small incisions are made in the abdomen, and long surgical instruments, along with a camera, are inserted to perform the surgery. This method results in smaller scars, potentially less pain, and a shorter recovery period compared to open surgery. However, it requires significant surgical skill and experience due to limited tactile feedback and the complexity of the procedure.

What is robotic-assisted radical prostatectomy?

Robotic-assisted radical prostatectomy is a minimally invasive approach to removing the prostate gland using robotic technology. The surgeon controls robotic arms equipped with surgical instruments from a console, offering enhanced precision, flexibility, and control. This method provides the surgeon with a magnified, high-definition 3D view of the surgical site. It typically results in less blood loss, smaller incisions, quicker recovery, and potentially better preservation of urinary and sexual function compared to traditional open surgery. However, the success of this technique largely depends on the surgeon's expertise and experience with robotic systems.

What is Retzius sparing prostatectomy?

Retzius sparing prostatectomy is a surgical approach for prostate cancer treatment that avoids disrupting the Retzius space, an area in the front of the bladder. This technique, often performed robotically, accesses the prostate from behind (posteriorly), preserving the structures in the Retzius space, such as the bladder and its supporting tissues. The primary advantage is a potential improvement in urinary continence recovery post-surgery, as the natural support of the bladder and urinary sphincter is maintained. It is suitable for certain patients depending on the prostate's anatomy and cancer characteristics.

What is pelvic lymph node dissection during prostatectomy?

Pelvic lymph node dissection during prostatectomy involves the removal of lymph nodes in the pelvic region to check for the spread of prostate cancer. This procedure is typically performed during radical prostatectomy when there is a significant risk of cancer spreading beyond the prostate gland. By analyzing the removed lymph nodes, pathologists can determine if cancer cells have spread to these nodes, which is crucial for staging the cancer and deciding on further treatment. The extent of lymph node dissection can vary based on the patient's risk and the surgeon's judgment.

What is nerve sparing in prostatectomy?

Nerve-sparing in prostatectomy is a surgical technique aimed at preserving the nerves that control erectile function, which run alongside the prostate gland. This approach is used during radical prostatectomy, where the surgeon carefully dissects and preserves these delicate nerves while removing the prostate. The goal is to maintain erectile function post-surgery, a significant concern for many patients undergoing prostate cancer treatment. Nerve-sparing is not always possible, depending on the cancer's location and extent. The feasibility of this technique and its success rate depend on various factors, including the patient's pre-surgery erectile function and the cancer's proximity to the nerves.

What are positive and negative surgical margins in prostatectomy?

A positive surgical margin in prostatectomy indicates that cancer cells are found at the edge of the removed tissue, suggesting that some cancer may have been left behind. This can occur if the cancer extends to the edge of the prostate and is not fully excised during surgery. A positive margin may increase the risk of prostate cancer recurrence. Conversely, a negative surgical margin means no cancer cells are found at the edges of the removed tissue, implying that the cancer was likely completely removed, which is a favorable outcome in prostate cancer surgery. This result generally indicates a lower risk of cancer recurrence, though continuous monitoring is still essential.

What are the benefits and risks of prostatectomy?

Prostatectomy, a surgical procedure for prostate cancer, offers potential benefits such as curing or controlling the spread of cancer and relieving symptoms from an enlarged or cancerous prostate. This can enhance survival rates and quality of life. However, it carries risks and side effects, including bleeding, infection, damage to nearby organs or nerves, urinary issues like incontinence or stricture, sexual dysfunction, infertility, and lymphedema. The severity and permanence of these side effects vary, influenced by the surgery type, surgeon's expertise, patient's age and health, cancer stage and grade, and whether nerve-sparing techniques were used. Some side effects may improve over time or require additional treatment.

How do I prepare for prostatectomy?

The short answer is to follow the instructions of your healthcare team. These could include necessary tests and consultations, including blood and urine tests, imaging like ultrasound, MRI, or CT scan, a biopsy, digital rectal examination, and a PSA test. Discuss with your surgeon the surgery type, benefits, risks, potential outcomes, alternatives, and the recovery process. Key questions for your surgeon might involve their experience, success and complication rates, type of anesthesia, hospital stay duration, pain management, recovery monitoring, cancer treatment efficacy, risks of urinary or sexual problems, coping strategies, and potential post-surgery treatments. Consider getting a second opinion. Before the procedure, quit smoking, stop certain medications, follow pre-surgery fasting guidelines, and arrange for post-surgery transportation and assistance.

What to expect after prostatectomy?

After a prostatectomy, you will be in a recovery room under observation for a few hours. You will have a catheter in your penis for urine drainage, an abdominal drain for blood or fluid removal, an IV line for fluids and medications, and a dressing on your wound. Expect some pain, discomfort, or numbness, managed with painkillers, and possibly nausea. Hospital stay typically lasts 1 to 3 days, during which vital signs, wound, drain, catheter, and PSA levels are regularly checked. You will receive blood thinners, physiotherapy, and dietary advice. Discharge depends on pain control, wound healing, catheter management, urinary function, and basic mobility. Upon leaving, you will get a discharge summary, medication prescriptions, follow-up appointments, and referrals to specialists if necessary.

How to recover from prostatectomy?

Recovery from a prostatectomy can span several weeks or months, varying with the surgery type and personal factors. During recovery, it is important to rest, avoiding heavy lifting, driving, or cycling. Careful wound care and hygiene, staying hydrated, and maintaining a balanced diet are essential. Performing pelvic floor exercises can strengthen muscles for better urinary and erectile control. Managing urinary leakage with pads or diapers and using aids for erectile dysfunction may be necessary. Emotional well-being is also crucial; seek support for any mental health concerns. Regular follow-ups for progress checks and PSA monitoring are important, with additional tests or treatments if there's any indication of cancer recurrence or spread.

How often do I have to follow up after prostatectomy?

Post-prostatectomy, follow-up frequency varies based on individual factors and the surgery's outcome. Initially, frequent check-ups may be necessary, typically every 3 to 6 months. These visits usually include PSA tests to monitor for cancer recurrence. Over time, if no issues arise, the interval between appointments may extend to annually. It is essential to adhere to your doctor's recommended schedule for optimal post-surgical care.

How is my sexual function affected by prostatectomy?

Sexual function can be impacted by prostatectomy, particularly erectile function. Nerve-sparing techniques may preserve sexual function, but some degree of change is common. Erectile dysfunction (ED) is a potential side effect, and its severity depends on factors like age, pre-surgery sexual function, and surgical technique. Various treatments for ED are available, including medications, devices, or counseling.

Can I live a normal life after prostatectomy?

Many men return to a normal life after prostatectomy. While recovery varies, most resume daily activities within a few weeks. Adjustments may be needed for urinary control or sexual function. With time, pelvic floor exercises, lifestyle changes, and medical support, quality of life often returns to pre-surgery levels.

Does prostatectomy affect my life expectancy?

Prostatectomy, especially when performed for localized cancer, can have a positive impact on life expectancy by effectively treating the cancer. The long-term outlook depends on cancer's nature and stage. Early-stage cancers treated with prostatectomy generally have a favorable prognosis.

Does prostatectomy affect fertility?

Prostatectomy does affect fertility, as it removes the prostate gland and seminal vesicles, both of which are integral to producing semen. After the surgery, men typically become infertile, meaning they cannot father a child through natural means. This is because ejaculation of semen is no longer possible, although orgasm may still occur. For men who wish to father children after prostatectomy, options like sperm banking or assisted reproductive technologies can be considered prior to the surgery. It is important for patients to discuss fertility concerns and options with their doctor before undergoing prostatectomy.

Conclusion

Prostatectomy is a significant surgical procedure for treating prostate cancer, with various implications for a patient's recovery, lifestyle, and long-term health. Post-surgery, patients should adhere to follow-up schedules for optimal recovery and monitoring. While the procedure can impact sexual function and fertility, there are treatments and strategies to manage these changes. Many men adapt well post-prostatectomy and can lead normal, active lives. The impact on life expectancy is generally positive, especially when treating localized prostate cancer. It is crucial for patients to have thorough discussions with their healthcare providers about all aspects of prostatectomy to make informed decisions.

Further Reading

  1. van Poppel H, Everaerts W, Tosco L, Joniau S. Open and robotic radical prostatectomy. Asian J Urol. 2019 Apr;6(2):125-128. PMID: 31061797.
  2. Hugosson J, Stranne J, Carlsson SV. Radical retropubic prostatectomy: a review of outcomes and side-effects. Acta Oncol. 2011 Jun:50 Suppl 1:92-7. PMID: 21604947.
  3. Dirie NI, Pokhrel G, Guan W, Mumin MA, Yang J, Masau JF et al. Is Retzius-sparing robot-assisted radical prostatectomy associated with better functional and oncological outcomes? Literature review and meta-analysis. Asian J Urol. 2019 Apr;6(2):174-182. PMID: 31061804.
  4. Tillu ND, Kulkarni JN. Long-term comparative outcome analysis of a robot-assisted laparoscopic prostatectomy with retropubic radical prostatectomy by a single surgeon. J Robot Surg. 2023 Apr;17(2):677-685. PMID: 36306101.

Disclaimer: This blog post is intended solely for informational purposes, based on the references cited. It is not meant to serve as medical advice. For professional medical guidance, please consult your doctor.

Comments

Popular posts from this blog

Prostate Cancer: An Overview

Prostate cancer is a concern for men, particularly those over 50 or with a family history of the disease. Understanding prostate cancer is crucial for early detection and effective management. While the prospect of prostate cancer can be daunting, advancements in medical science have made it a highly manageable condition, especially when diagnosed early. In this article, I provide an overview of prostate cancer. Prostate cancer: Location of the prostate gland . Source . What is Prostate Cancer? Prostate cancer is a type of cancer that occurs in the prostate, a small walnut-shaped gland in men that produces the seminal fluid that nourishes and transports sperm. This cancer is one of the most common types affecting men and tends to grow slowly, often confined to the prostate gland initially, where it may not cause significant harm. However, while some types of prostate cancer grow slowly and may need minimal or no treatment, others are aggressive and can spread quickly and become metasta

What Is Kidney Cancer?

Kidney cancer is a type of cancer that starts in the kidneys, the two bean-shaped organs located on either side of the spine, just below the rib cage. The kidneys play a crucial role in filtering blood, removing waste products and excess fluids, and producing urine. Understanding kidney cancer is vital for early detection and effective treatment. This comprehensive overview covers the basics of kidney cancer, including its types, causes, symptoms, and treatment options. What is Kidney Cancer? Kidney cancer occurs when cells in the kidney grow uncontrollably, forming a tumor. In most cases, kidney cancer originates in the lining of the tiny tubes inside the kidneys (renal tubules). The cancer can spread (metastasize) to other parts of the body if not detected early. There are several types of kidney cancer, with the most common being renal cell carcinoma (RCC). Other less common types include urothelial carcinoma and Wilms tumor, which typically affects children. Causes and Risk Factors

Metastatic Prostate Cancer

Metastatic prostate cancer means that the cancer has spread beyond the prostate gland to other parts of the body. The likelihood of developing metastatic prostate cancer depends on various factors, including the stage and grade of the cancer at initial diagnosis, age, genetic predispositions, and overall health. Generally, prostate cancers identified early and at a lower grade have a lower risk of becoming metastatic. However, aggressive, or high-grade tumors are more likely to spread beyond the prostate. Bone metastasis of prostate cancer in F-18-Choline PET-CT Scan. Source .  How does metastatic prostate cancer spread? Prostate cancer can metastasize to other internal organs in several ways. One method of metastasis is through the blood vessels, where the cancer cells enter the bloodstream and travel to distant organs. Another pathway is through the lymphatic system, wherein the cancer cells can infiltrate the lymph nodes near the prostate and subsequently spread to other lymph node

How is Kidney Cancer Diagnosed?

Understanding how kidney cancer is diagnosed is crucial for anyone seeking information about this disease, which starts in the kidneys—the organs responsible for filtering waste from the blood and creating urine. Early detection can significantly impact treatment outcomes, making awareness of the diagnostic process essential. This guide aims to break down the steps and methods used by healthcare professionals to diagnose kidney cancer, ensuring you are well-informed about this critical phase of cancer care. Recognizing the Symptoms Often, kidney cancer does not cause noticeable symptoms in its early stages. However, as the cancer grows, symptoms such as blood in the urine (hematuria), lower back pain on one side (not caused by injury), a mass or lump on the side or lower back, fatigue, unexplained weight loss, or fever may prompt a visit to the doctor. Recognizing these signs and seeking medical advice is the first step in the diagnostic process. Initial Consultation and Physical Exam

Urine Cytology to Diagnose Bladder Cancer

Urine cytology is a crucial diagnostic test used in the detection of bladder cancer. This test involves examining urine samples under a microscope to identify abnormal cells that could indicate the presence of cancer. This article provides an in-depth look at how urine cytology is used to diagnose bladder cancer, its effectiveness, and its role in the broader context of bladder cancer detection and monitoring. Understanding Urine Cytology Urine cytology is a non-invasive diagnostic procedure that helps detect bladder cancer , especially in its early stages. During this test, a urine sample collected from the patient is sent to a laboratory where a cytologist or a pathologist examines the sample under a microscope. The goal is to look for cancerous or pre-cancerous cells shed into the urine from the lining of the bladder. This test is particularly valuable because it can detect cells from tumors that might be missed by other diagnostic methods. How Urine Cytology Is Performed The proces

Benign Prostatic Hyperplasia or BPH

Benign prostatic hyperplasia, commonly known as BPH, is a common condition affecting the prostate gland of men as they age. Characterized by the enlargement of the prostate gland , BPH can significantly impact urinary function and quality of life. This enlargement is non-cancerous but can lead to uncomfortable urinary symptoms. Benign prostatic hyperplasia, commonly known as BPH, is the enlargement of the prostate gland affecting men as they age. Source . How common is benign prostatic hyperplasia? BPH is a very common condition, especially as men age. It is estimated that about half of men over the age of 50 have some degree of benign prostatic hyperplasia, with the number increasing to about 90% of men over 80. Despite its prevalence, not all men with an enlarged prostate experience significant symptom. What causes benign prostatic hyperplasia? The exact cause of benign prostatic hyperplasia is not fully understood, but it is believed to be linked to age-related hormonal changes. As

Prostate Specific Antigen (PSA)

Prostate specific antigen (PSA) is a protein produced by both normal and cancerous cells of the prostate gland. The PSA test measures the level of PSA in the blood and can help detect prostate cancer in men who have no symptoms. However, the PSA test is not perfect and has some limitations and controversies. In this blog post, we will discuss some of the important aspects of PSA testing, such as age-specific PSA levels, free and bound PSA, diagnostic value of PSA, and controversies surrounding PSA screening. Human prostate specific antigen with bound substrate from complex with antibody. Source . Age-specific PSA levels It is normal for all men to have some PSA in their blood, but the amount tends to increase with age. Therefore, some experts have suggested using age-specific PSA ranges to interpret the results of the PSA test. For example, one study proposed the following age-specific PSA ranges for men with no prostate cancer symptoms:  40 to 49 years: 0 to 2.5 ng/mL  50 to 59 years:

Chronic Kidney Disease (CKD) - Causes, Symptoms and Treatment

Chronic Kidney Disease (CKD) is a long-term condition where the kidneys gradually lose their ability to function properly. This progressive loss of function impairs the kidneys' ability to filter waste and excess fluids from the blood, leading to a buildup of harmful substances in the body. CKD can eventually lead to kidney failure, requiring dialysis or a kidney transplant for survival. Understanding CKD is crucial for managing the condition and improving the quality of life for those affected. Types of Chronic Kidney Disease (CKD) Chronic Kidney Disease is classified into five stages based on the severity of kidney damage and the level of kidney function. Stage 1 indicates mild kidney damage with normal or slightly decreased kidney function, while Stage 5, also known as end-stage renal disease (ESRD), represents severe kidney damage with significantly reduced kidney function. CKD can be caused by various underlying conditions, including diabetes, high blood pressure, and genetic

Electrolyte Imbalance - Causes, Symptoms, and Treatment

Electrolyte imbalance occurs when the levels of essential minerals in the body, such as sodium, potassium, calcium, and magnesium, are either too high or too low. These minerals, known as electrolytes, play a crucial role in maintaining many of the body’s vital functions, including nerve signaling, muscle contraction, and fluid balance. When electrolyte levels are not properly balanced, it can lead to a range of health issues, some of which can be life-threatening if not addressed promptly. Understanding the nature of electrolyte imbalances, their causes, symptoms, and treatments is important for maintaining overall health. Types of Electrolyte Imbalance Electrolyte imbalances can occur with any of the body’s essential minerals, but the most common types involve sodium, potassium, calcium, and magnesium. Hyponatremia occurs when sodium levels are too low, leading to symptoms like confusion, seizures, and muscle weakness. Hypernatremia, on the other hand, occurs when sodium levels are t

Muscle-Invasive Bladder Cancer

Muscle-invasive bladder cancer is a serious form of bladder cancer that penetrates the muscle layer of the bladder wall. This type of cancer is more aggressive and has a higher risk of spreading compared to non-muscle-invasive bladder cancer. Understanding muscle-invasive bladder cancer, its symptoms, diagnosis, and treatment options is crucial for effective management and improving patient outcomes. This comprehensive guide aims to provide clear and accessible information about this challenging condition. What is Muscle-Invasive Bladder Cancer? Muscle-invasive bladder cancer occurs when cancer cells grow into the muscularis propria, the thick muscle layer of the bladder wall. This type of cancer represents approximately 25% of all bladder cancer cases at diagnosis. It is considered more serious than non-muscle-invasive bladder cancer because it has a higher potential to spread to other parts of the body, including lymph nodes and distant organs. Symptoms of Muscle-Invasive Bladder Can