Articles on Prostate Cancer
When do doctors consider surgery for prostate cancer?
Radical prostatectomy, or surgical removal of the entire prostate gland, isn’t typically the first choice in prostate cancer treatment, but sometimes a radical approach is necessary to keep cancer from metastasizing.
Cancer of the prostate, the male gland in the pelvis that produces the fluid part of semen, is one of the most common cancers in men. Because it’s so common and tends to be slower-growing than many other kinds of cancer, there is a variety of radiological, chemotherapy, immunotherapy, and other non-invasive treatments that have shown success in stopping prostate cancer’s progression.
Some cases are too severe or diagnosed too late for drugs or radiation to have much effect, however. In these cases, treatment teams may opt for radical prostatectomy, despite potential side effects like impotence and incontinence.
What do they do to remove your prostate?
The removal of the entire prostate gland and the urethra that runs through the prostate and the attached seminal vesicles is referred to as a radical prostatectomy. A variety of approaches are available for performing this procedure. The type of approach may vary with your surgeon's preference, your physique, and medical conditions. Traditionally, radical prostatectomy was performed through an incision that extended from below the belly button (umbilicus) down to the pubic bone or through an incision underneath the scrotum (perineal approach). In an effort to decrease the chance of complications or bad outcomes from the procedure, laparoscopic approaches to performing a radical prostatectomy were developed. The use of the robot to perform the laparoscopic radical prostatectomy, robotic-assisted radical prostatectomy, is currently the most common method to perform a radical prostatectomy. Compared to open radical prostatectomy, robot-assisted laparoscopic radical prostatectomy is associated with less postoperative discomfort and sooner return to full activity, as well as less intraoperative blood loss with comparable outcomes regarding urinary continence and erectile function. Radical prostatectomy is an appropriate treatment option for those individuals with clinically localized prostate cancer that can be removed completely surgically and who have a life expectancy of 10 or more years and have no medical contraindications to surgery.
In some men, a pelvic lymph node dissection may be recommended depending on the staging or the Gleason score, PSA, and radiologic findings. This involves removing lymph nodes in the pelvis that are common sites for prostate cancer to spread. This may be performed at the time of the radical prostatectomy or rarely as a separate procedure prior to definitive therapy.
What are the side effects of radical prostatectomy?
Side effects of radical prostatectomy may have a significant impact on quality of life. Thus, it is essential that you discuss with your surgeon prior to the surgery the risk of such side effects occurring, as well as treatments that can occur after surgery to treat such sides effects.
- Erectile dysfunction is a side effect of radical prostatectomy. The risk of developing erectile dysfunction varies with your age, erectile function status prior to surgery, and the need to remove one, both, or neither of the pelvic nerve bundles during the radical prostatectomy.
- The pelvic nerve bundles lie on either side of the prostate, just outside the capsule or outer edge of the prostate. The pelvic nerve bundles are involved in the erectile process, the ability to have an erection. Impotence, or the inability to have and sustain an erection of a quality sufficient for successful intercourse, can occur after radical prostatectomy due to trauma, damage, or removal of the pelvic nerve bundles. Nerve-sparing radical prostatectomy can be performed in select individuals with lower-risk prostate cancer. Even after nerve-sparing radical prostatectomy, one may experience transient erectile troubles related to reversible trauma to the nerves during surgery.
Specialists treating erectile dysfunction may recommend penile rehabilitation therapy in hopes of helping the nerves recover their function better and faster after radical prostatectomy.
- Urinary incontinence is another risk after a radical prostatectomy. The radical prostatectomy involves the removal of a portion of the urethra, which passes through the prostate gland. During the procedure, the urethra is sewn back to the bladder. When the prostate gland is removed, there may be some trauma to the sphincter around the urethra, which helps prevent leakage of urine. As with the risk of erectile troubles, the risk of incontinence may vary with your continence status prior to surgery, whether or not you have had prior surgery on the prostate (transurethral prostatectomy [TURP]), and the function of your sphincter muscle prior to surgery.
Both erectile dysfunction and urinary incontinence are treatable conditions. The treatment for either may involve medical and/or surgical therapies. You should discuss such risks and the treatment of these with your surgeon prior to surgery.
Other risks of prostate removal
Other risks of radical prostatectomy include
To help prevent a DVT, you may be asked to wear special compression devices on your legs or be administered a blood thinner.
Radical prostatectomy is rarely performed as a salvage procedure after other primary therapy, such as radiation therapy, has failed. The risk of complications, such as erectile dysfunction, incontinence, bleeding, and stricture, is greater with salvage therapy.
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American Cancer Society (ACS). <http://www.cancer.org/cancer/prostatecancer/index>.
American Urological Association. "Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline." 2017. <http://www.auanet.org/guidelines/clinically-localized-prostate-cancer-new-(aua/astro/suo-guideline-2017)>.
Byrd, E.S., et al. AJCC Cancer Staging Manual, 7th Ed. New York, NY: Springer, 2009.
The James Buchanan Brady Urological Institute. Johns Hopkins Medicine.
Lu-Yao, G.L., P.C. Albertson, D.F. Moore, et al. "Fifteen-year outcomes following conservative management among men aged 65 years or older with localized prostate cancer." Eur Urol 68.5 (2015): 805-811.
Mottet, Nicolas, et al. "Updated Guidelines for Metastatic Hormone-Sensitive Prostate Cancer: Abiraterone Acetate Combined With Castration Is Another Standard." European Urology 73 (2018): 316-321.
National Comprehensive Cancer Network
"Prostate Cancer." Memorial Sloan Kettering Cancer Center.
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- Risk factors include age, family history, ethnicity, and diet.
- Prostate cancer is diagnosed by a digital rectal exam, prostate-specific antigen (PSA) test, and prostate biopsy.
- Symptoms may include
- frequent need to urinate,
- incontinence, pain,
- blood in the urine,
- fatigue, and more.
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- cryotherapy, and
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