Surgery is a common choice to try to cure prostate cancer if you believe it has not spread to the outside of the gland (stage cancers T1 or T2).
The main type of surgery for prostate cancer is known as radical prostatectomy . In this operation, the surgeon removes the entire prostate gland plus some of the surrounding tissue, including the seminal vesicles. A radical prostatectomy can be done in different ways.
Methods open prostatectomyIn the more traditional method of making a prostatectomy, the surgeon operates through a single long incision to remove the prostate and surrounding tissues. This method is called open .
Retropubic radical prostatectomyFor this operation, the surgeon makes an incision in the skin of the lower abdomen from the navel to the pubic bone. During surgery, along with sedation may be given general anesthesia (you are asleep) or spinal or epidural (numb you lower body).
If there is a reasonable likelihood that the cancer has spread to lymph nodes (according to their level of PSA, digital rectal examination and biopsy results), the surgeon may remove the lymph nodes around the prostate at this time. Usually lymph sent to a pathology lab to see if cancer cells (takes several days to get the results), but in some cases can be examined lymph immediately. If to examine lymph during surgery either of them has cancer cells, which means that the cancer has spread, the surgeon can stop surgery. This is because it is unlikely that the cancer is cured by surgery to remove the prostate and may even cause serious side effects.
When the prostate is removed, the surgeon will pay close attention to two small groups of nerves that run on both sides of the prostate. These nerves control erections. If you could have erections before surgery, the surgeon will try not to damage these nerves (method of preservation of the nerves ). If the cancer is growing into or very close to the nerves, the surgeon will have to remove them. If both are removed, you can not have spontaneous erections. This means that you need help (such as drugs or bombs) to have erections. If the nerves are removed from one side, you still have a chance to preserve their ability to achieve erections, but that likely will be less than if he had not removed any. If not removed any of the nerve bundles, then you could run normally. Usually after surgery takes several months to a year to get an erection because the nerves have been touched during operation and will not function properly for a while.
After surgery, while you are still under the effects of anesthesia, a catheter will be placed on the penis to help drain the bladder. The catheter usually remain in place for one to two weeks during the recovery period. You can urinate on your own once you remove the catheter.
After surgery, you'll probably stay in the hospital for several days. Furthermore, their activities will probably limited by around 3 to 5 weeks. Possible side effects of prostatectomy described below.
radical perineal prostatectomy.
After surgery, you'll probably stay in the hospital for several days. Furthermore, their activities will probably limited by around 3 to 5 weeks. Possible side effects of prostatectomy described below. radical perineal prostatectomy
In this operation, the surgeon makes an incision in the skin between the anus and scrotum (perineum), as illustrated in the picture above. This method is used less frequently because it is not easily possible to preserve the nerves and can not be removed lymph nodes. However, surgery is often shorter and may be an option if you do not want the nerve-sparing procedure and is not required to remove lymph nodes. Moreover, it is often easier to recover from this operation. Can also be used if you have other medical conditions that hinder retropubic surgery. If done properly, can be as healing as the retropubic approach. The perineal operation usually takes less time than the retropubic operation, and cause less pain.
After surgery, while you are still under the effects of anesthesia, a catheter will be placed on the penis to help drain the bladder. The catheter usually remain in place for one to two weeks during the recovery period. You can urinate on your own once you remove the catheter.
After surgery, you'll probably stay in the hospital for several days. Furthermore, their activities will probably limited by around 3 to 5 weeks. Possible side effects of prostatectomy described below.
Methods for laparoscopic prostatectomy
In laparoscopic methods, several incisions are made smaller with special surgical instruments to remove the prostate. This procedure may be performed while the surgeon holding the instrument directly or using a control panel to accurately move the robotic arms which hold the instruments.
LRPIn a laparoscopic radical prostatectomy ( laparoscopic radical prostatectomy, LRP), the surgeon makes several small incisions through which instruments are inserted special long to remove the prostate. One of the instruments has a small video camera on the end, allowing the surgeon to see inside the abdomen.
Laparoscopic prostatectomy has advantages over conventional open radical prostatectomy, including less blood loss and pain, shorter stays in the hospital (usually no more than a day) and shorter recovery periods (although it will be necessary to use the catheter for about the same amount of time).
The LRP has been used in the United States since 1999 and has become community centers and universities. When performed by physicians experienced in the procedure, laparoscopic radical prostatectomy appears to be as effective as open radical prostatectomy, but still do not have the long-term results of the procedures done in the United States.
Preliminary studies reported that rates of side effects of LRP seem to be almost the same as those of open prostatectomy. (These side effects are described below). With this method, it may be slightly delayed recovery of bladder control. A method of nerve preservation is possible with LRP, which increases the probability of normal erections after surgery.
Radical prostatectomy Robot-assisted laparoscopic
A newer method is to make remote laparoscopic surgery using a robotic interface (da Vinci), which is known as robot-assisted laparoscopic prostatectomy (RALRP). The surgeon sits at a panel near the operating table and controls the robotic arms to perform the operation through several small incisions are made in the patient's abdomen.
Like the direct LRP, the robot-assisted laparoscopic prostatectomy has advantages over the open method in terms of pain, blood loss and recovery time. However, so far there seems to be little difference between the direct LRP and robotics for patients.
In terms of side effects of most concern to men, like urinary problems or erectile dysfunction (described below), appears to be no difference between LRP and robot-assisted prostatectomy other methods.
For the surgeon, the robotic system can provide more maneuverability and precision when moving the instruments to conventional laparoscopic radical prostatectomy. Still, the experience, the commitment and skill of the surgeon are the most important factors in the success of any of the two types of laparoscopic radical prostatectomy.
Radical prostatectomy Robot-assisted laparoscopic has been used in the United States since 2003. Because it is still a relatively new way of doing the surgery, reports long-term results are not yet available. However, this method has become more popular in recent years, and is currently the method most often used to perform a prostatectomy.
If you are considering treated with either radical prostatectomy rates, it is important to understand what is known and what remains unknown about this method. Again, the experience and skill of the surgeon are probably the most important factors. If you choose either of the two types of laparoscopic radical prostatectomy is the treatment for you, make sure you find a surgeon who has extensive experience with this procedure.
possible ricks and side effects of radical prostatectomy (LPR including)
There are possible risks and side effects with any surgery for prostate cancer.
Surgical risksThe risks associated with any kind of radical prostatectomy are similar to those of any major surgery, including the risks of anesthesia. Among the most serious risks are heart attack, stroke, blood clots in the legs that may travel to the lungs and an infection in the incision area.
If lymph nodes are removed, they can form an accumulation of lymphatic fluid (called lymphocele ), which would require it to drain.
Because there are many blood vessels close to the prostate gland, another risk is bleeding during and after surgery. You may need blood transfusions, which in itself carries a lower risk. In rare cases, you may be part of the small cut during surgery. This could cause infections in the abdomen and may require further surgery to correct this problem.
In some infrequent cases, the patient may die from complications of the operation. The risk depends in part on your overall health, age and experience of the surgical team.
Side Effects
The main side effects of radical prostatectomy are urinary incontinence (lack of bladder control) and impotence (the inability to have erections). These side effects may also occur with other forms of treatment for prostate cancer, which is described below.
Urinary incontinence: you may have urinary incontinence, which means you can not control urination or presenting something blasting or involuntary leakage of urine. Different degrees of incontinence. Having incontinence can affect you not only physically, but emotionally and socially. There are three main types of incontinence:
- The incontinence is the most common type of incontinence after prostate surgery. Men with stress incontinence leak urine when coughing, laughing, sneezing or exercising. It is usually caused by problems with the muscular valve that keeps urine in the bladder (bladder sphincter). Treatments for prostate cancer can damage the muscles that make this valve or the nerves that keep the muscles working.
- Men with overflow incontinence or can not empty your bladder well. They take a long time to urinate and have a dribbling stream with little force. Generally overflow incontinence is caused by blockage or narrowing of the outlet of the bladder due to scar tissue.
- Men with urge incontinence have a sudden need to go to the bathroom and urinate. This problem occurs when the bladder becomes too sensitive to stretching as it fills with urine.
In rare instances, men lose all ability to control urination after surgery, which is known as continuous incontinence .
After surgery for prostate cancer, normal control of bladder usually returns within several weeks or months. Recovery usually occurs gradually, in stages.
Doctors can not predict with certainty how a man will be affected after surgery. In general, older men tend to have more problems with incontinence than younger men. In a study involving men 55 to 74 years who were treated in all types of hospitals, researchers found the following 5 years after radical prostatectomy:
- 15% of men had no bladder control or leak or drip had frequent urination.
- 16% had urine leakage at least twice a day.
- The 29% used sanitary pads to keep dry.
(Some of the men were in two or three of these groups, so adding these percentages together overstates the likelihood of urinary problems).
Most of the great centers of cancer treatment in which surgery is performed more frequently prostate, and in which surgeons have more experience, report fewer problems with incontinence.
Treatment of incontinence depends on the type, cause and severity. If you have incontinence problems, talk to your doctors. You may feel embarrassed to discuss this matter, but remember that you are not alone. This is a common problem. Doctors who treat men with prostate cancer should be aware of incontinence problems and be able to suggest measures to correct it, such as:
- Special exercises , called exercises Kegel, can help strengthen the muscles of the bladder. These exercises involve tensing and relaxing certain pelvic muscles. Not all doctors agree about the usefulness or the best way to do the exercises. Therefore, ask your doctor about exercises Kegel before starting them.
- Medicines that help the muscles of the bladder or sphincter. Most of these drugs affects the muscles or nerves that control them. These medicines are more effective for some forms of incontinence such as urge incontinence, than for others.
- Surgery to correct the long-term incontinence. It can inject a material, such as collagen to tighten the bladder sphincter. If your incontinence is severe and does not improve on its own, it is possible the surgical implantation of an artificial sphincter or can implant a small device called a urethral sling to support the bladder neck in place. Ask your doctor if these treatments can help you.
Even if your incontinence can not be fully correct, will still be helped. You can learn to manage and live with their incontinence. Incontinence is more than a physical problem that can disrupt your quality of life if not treated well. There is no one right way to treat incontinence. The challenge is to discover what is most appropriate for their daily activities back to normal.
There are many products for incontinence that can help you stay active and comfortable, such as pads that can be worn under clothing. Adult boxers and underwear are bulkier than the pads but provide more protection. You can also use bed pads or absorbent mattress pads (linings) that protect the sheets and mattress.
When choosing incontinence products, consider the following checklist. It is possible that some of these questions are not important to you or you may have others to add.
- Absorbency: how much the product provide? How long will it protect?
- Size: Can it be seen under normal clothing? Is it disposable? Can it be reused?
- Comfort: how do you feel when you move or sit down?
- Availability: what stores sell products? Are they easily accessible?
- Cost: Does your insurance these products?
Another option is called a rubber condom catheter that is placed over the penis to collect urine in a bag. There are also compression devices (pressure) that can be placed on the penis for short periods of time to help prevent urine from leaking.
The catheterization may be an option for some types of incontinence. In this approach, you insert a thin tube into your urethra to drain and empty the bladder during periodic intervals. Most men can learn this technique, it is safe and usually painless.
In addition, you can take some simple precautions that can make incontinence less problematic. For example, empty the bladder before going to bed or before performing any strenuous activity. Avoid drinking plenty of fluids, especially if drinks containing caffeine or alcohol, as these can cause you to urinate more often. Because belly fat can put pressure on the bladder, sometimes weight loss helps improve bladder control.
Fear, anxiety and anger are common feelings experienced by people who are dealing with incontinence. The fear of having an accident can cause you to suspend the activities you enjoy most, for example, bring their grandchildren to the park, going to the movies or playing golf. You may feel isolated and embarrassed. You may even avoid sex for fear of having a urine leakage. Be sure to talk with your doctor so you can begin to manage the problem, because as noted above, there are many solutions.
Impotence (Erectile Dysfunction): this means that you can not achieve an erection sufficient for intercourse. The nerves that allow men to get erections may be damaged or may have been removed by radical prostatectomy. Other treatments (besides surgery) may damage these nerves or blood vessels that supply blood to the penis to produce an erection.
After this operation, the ability to achieve erections depends on the age, you had the ability to achieve erections before the operation, and if the nerves were cut. Hopefully a reduction in the ability to have erections, but the younger you are, the more likely that you retain this ability.
It has been reported a wide range of rates of impotence in the literature ranging from rates as low as about one in four men under 60 to as high as about three in four men over age 70. Doctors who perform many radical prostatectomies with nerve sparing t tend to report lower impotence handles doctors who perform surgery less often.
Everyone's situation is different man. Therefore, the best way to get an idea of your chances of recovering erections is to ask your doctor about their success rates and what the prognosis would probably be in your particular case.
If your ability to achieve erections back after surgery, this often happens slowly. In fact, this may take up to two years. During the first few months, you probably can not get an erection spontaneously, so you may need medication or other treatment.
If after surgery power persists, the sensation of orgasm should remain pleasant, but no semen ejaculation (orgasm is "dry"). This is because during prostatectomy glands that produce most of the fluid for semen (the seminal vesicles and prostate) were excised, and the ways in passing sperm (vas deferens) were cut.
Most doctors feel that regaining power is aided by the attempt to achieve an erection as soon as possible once the body has had a chance to heal (usually several weeks after the operation). Some doctors call this penile rehabilitation . Use of Medicines (see below) may be useful at this time. Be sure to talk with your doctor about your particular situation.
Several options are available if you have erectile dysfunction.
- The phosphodiesterase inhibitors such as sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are drugs that can promote erections. These drugs will not work if both nerves that control erections are damaged or were removed. The most common side effects are headache, flushing (the skin turns red and feels warm), indigestion, light sensitivity and a runny or stuffy nose. Rarely, these drugs can cause vision problems, possibly even blindness. Nitrates, which are drugs used to treat cardiac disorders, can interact with these medications and cause very low blood pressure, which can be dangerous. Some other medications can also cause problems. Therefore, make sure you tell your doctor what medicines you take.
- The alprostadil is an artificial version of prostaglandin E1 , a substance that occurs naturally in the body, and can cause erections. This medicine may be injected at the base of the penis almost painlessly, 5 to 10 minutes before intercourse, or can be placed on the tip of the penis like a suppository. You can even increase the dosage to prolong erection. You may have side effects such as pain, dizziness and prolonged erection, but these effects are usually minimal.
- The vacuum devices are another option to create an erection. These mechanical pumps are placed around the penis before intercourse to produce an erection.
- If other methods do not help, the penile implants may regain the ability to have erections. Operation is required to place the implant in place. There are several types of penile implants, including those using silicone rods or inflatable device.
For more detailed information on how to deal with erection problems and other issues related to sexuality, see our document
Sexuality for the Man With Cancer .
Changes in orgasm: in some men, orgasms can be less intense or disappear altogether. Some men report pain at orgasm. Even if you have impotence problems, you may still have orgasms.
Infertility: a radical prostatectomy is cutting the connection between the testicles (where sperm are produced) and the urethra. Your testicles will still produce sperm, but it will not be released as part of the ejaculate. This means that a man can no longer father a child naturally. Often, this is not a problem because men with prostate cancer tend to be older. However, if you are concerned about this, you can talk to your doctor about "banking" their sperm before surgery.
Lymphedema: a rare complication, but possible, removing many of the lymph nodes around the prostate is a condition called lymphedema. Usually lymph nodes are a way for the return of fluid from the body to the heart. When nodes are removed, fluid may accumulate in the legs or in the genital region with the passage of time, which causes inflammation and pain. Usually, this condition can be treated with physical therapy, but may not disappear completely.
Change in penis length: one possible minor effects of the surgery is a reduction in the length of the penis. This may probably be due to a shortening of the urethra that occurs when a portion of it removed along with the prostate.
Inguinal hernia: prostatectomy increases the odds that a man suffering from an inguinal hernia (groin) in the future.
Transurethral resection of the prostate
Transurethral resection of the prostate ( transurethral resection of the prostate , TURP) is most frequently used to treat men with noncancerous enlargement of the prostate, known as benign prostatic hyperplasia (BPH). A TURP is not used to try to cure prostate cancer, but is sometimes used in men with advanced prostate cancer to help relieve symptoms such as urinary problems.
During this operation, the surgeon removes the inner part of the prostate that surrounds the urethra (the urethra is the tube through which urine leaves the bladder). This surgery is not necessary to make an incision in the skin. An instrument called a resectoscope inside the urethra by entering the end of the penis up to the level of the prostate. Once that is in place, electricity is passed through a wire to heat or a laser is used to cut or vaporize tissue. It is administered either spinal anesthesia (which numbs the lower body) or general anesthesia (where you are asleep).
The operation usually lasts one hour. After surgery, a catheter is inserted into the bladder through the penis. It remains in place about a day to help drain urine while the prostate heals. Generally, you must stay in the hospital one or two days and can return to normal activities within a week or two.
It is likely that some blood in the urine after surgery. Other possible side effects of TURP include infections and any risks associated with the type of anesthesia that is given.
