Radical Prostatectomy

What are the treatment for Prostate Cancer?

Radical prostatectomy is surgery (operation) performed to remove enlarged (overgrown) prostate gland and surrounding tissues .Tissues surrounding prostate include the seminal vesicles and nearby lymph nodes. This procedure can completely cure cancer of prostate that is localized (restricted only to prostate gland).

Safety:

As safe as traditional any other surgeries with Minimal blood loss, pain, blood transfusion may not be necessary, only overnight hospital stay.

Length of Surgery:

3- 4 hours.

Prostate Cancer Diagnosis:

Radical Prostatectomy is recommended after the following diagnosis tests:

  • Physical exam
  • Medical history.
  • X-ray.
  • CT scan.
  • MRI scan.
  • Sonogram.
  • KUB ( abdominal X-ray)
  • EKG (electrocardiogram)
  • CBC (complete blood count)
  • PT / PTT (blood coagulation profile)
  • Comprehensive Metabolic Panel (blood chemistry profile)
  • Urinalysis
  • Biopsy
  • PSA levels

Treatments For Prostate Cancer:

For the prostate cancer limited to prostate gland, radical prostatectomy can be performed.
However, urologist can suggest other options besides surgery. These may include

  • radiation therapy,
  • hormone therapy,
  • Watchful waiting of the prostate cancer for some time, as many prostate cancers tend to grow slowly.

Preparation:

Certain medications to be specifically avoided pre surgery:

  • Aspirin.
  • Ibuprofen Motrin.
  • Voltaren, Plavix, Lovenox, Vioxx, Celebrex.
  • Advil, Ticlid, Alka Seltzer, Coumadin, Vitamin E.
  • Arthritis medications: avoided since before a week of the surgery otherwise it can cause bleeding during the surgery.
  • The urine culture analysis should be negative.
  • In case of UTI Urinary Tract Infection, it should be treated before the surgery by prescribed antibiotics.
  • In case of severe lung/ heart conditions, it is advisable to exercise extra caution before and during the procedure

Radical Prostatectomy Procedure:

  • Radical prostatectomy is carried out under general anesthesia.
  • The patient is kept lying down on the abdomen.
  • The bladder’s telescopic examination known as cystoscopy is performed.
  • Surgeon (urologist) can choose a traditional approach called as open prostatectomy to remove entire prostate gland and seminal vesicles plus nearby lymph nodes.
  • The most recent approach resorted is minimally invasive procedures for radical prostatectomy:
    1. Laparoscopic prostatectomy
    2. Robot-assisted laparoscopic prostatectomy.

Open prostatectomy

In a traditional approach of radical prostatectomy, the urologist takes a vertical incision ( cut in skin and tissues below) approximately 8- to 10-inch long below the umbilicus ( belly button). The entire prostate gland and surrounding tissue ( as required) is removed through this incision. Another approach is to take cut (incision) in the perineal region (area between anus and the scrotum) to perform the operation. But this is done very rarely.

Laparoscopic prostatectomy

This procedure is performed under visualization (video). Surgeon takes many small cuts (incisions) on abdominal wall and the laparoscope (attached with camera) is inserted in abdomen to locate internal organs – prostate and radical prostatectomy is carried out from outside the body while watching the entire procedure on monitor screen.

Robot-assisted laparoscopic prostatectomy

Similar to laparoscopic prostatectomy, small incisions are made through the abdominal wall. An advanced laparoscope equipped with robotic system is inserted and urologist (surgeon) performs radical prostatectomy using 3-D screen assisted by high-tech interface which allows the surgeon natural wrist movements that can be controlled from outside the body.

Radical Prostatectomy Complications:

Unintentional damage to the nerves, those pass through prostate gland onwards to urethra (penis) may occur during radical prostatectomy. The potential risks include:
1. Urinary incontinence
2. Erectile dysfunction (ED): Although, functional problems of erections are common after prostatectomy, many men are able to have sex after prostatectomy.

It is advisable to get radical prostatectomy done at institute/ hospital/ center for Advanced Prostate Cancer treatment facility to minimize damage to these nerves and consequent complication. Other complications of radical prostatectomy include:

  • Bleeding after the operation
  • Urinary leaks
  • Blood clots
  • Infection
  • Poor wound healing ( following open surgery)
  • Groin hernia
  • Narrowing of the urethra, blocking urine flow

Less than 10% of men experience complications after prostatectomy, and these are usually treatable or short-term.

  • Failure to remove the prostate gland.
  • Need of an open surgery.
  • Bleeding.
  • Fever.
  • Nausea.
  • Constipation.
  • Fatigue.
  • Urinary abnormalities.
  • Infection.
  • Lower body aches.
  • Organ/ Tissue Injury
  • Urinary Catheter to drain the bladder.
  • Mobilization/ Ambulation: Important to begin walking a day after surgery, to prevent blood clots.
  • Re-operation in case of complications or incomplete removal of gland.

Follow- up:

  • 24 hour surveillance.
  • Visit doctor: for removal of cathedral after surgery.
  • Emergency Follow up:
  • Chest pain/ breathing difficulty.
  • Vomiting/ nausea
  • Worsening pain.
  • Large amounts of blood clots in the urine.
  • Difficult/ painful voiding and fully emptying the bladder.
  • Hospital-stay for one to three days after radical prostatectomy.
  • During the operation, urinary catheter is inserted and few patients may be required to wear the catheter for some more days to a few weeks even after discharge from hospital.
  • Retaining catheter kept in skin after surgery should be there for some more days after discharge from hospital.

All above, treatments are finalized taking into consideration the overall health, severity, age and other ailments of the patient. Only a well experienced urologist should perform the above treatment.