Prostate Cancer
Radical Prostatectomy
Prostate Cancer and Symptoms
Radical prostatectomy is an operation to remove the prostate gland and tissues surrounding it. This usually includes the seminal vesicles and some nearby lymph nodes. Radical prostatectomy can cure prostate cancer in men whose cancer is limited to the prostate. The prostate gland lies just under the bladder, in front of the rectum.
Surgeons choose from two different approaches to reach and remove the prostate during a radical prostatectomy.
Open prostatectomy- This is a traditional method in which the surgeon makes an vertical incision about 8-10-inch below the belly button. In rare cases , the incision is made in the space between the scrotum and the anus.
Laparoscopic prostatectomy- In this method the surgeon makes several small incisions across the belly. Surgical tools and a camera are inserted through the incisions, and a radical prostatectomy is performed from outside the body.The surgeon views the entire operation on a screen.
Robotic prostatectomy- Small incisions are made in the belly. A surgeon controls an advanced robotic system of surgical tools from outside the body. A high tech interface lets the surgeon use the movements and a 3-D screen during radical prostatectomy.
SYMPTOMS
- A frequent, urgent need to urinate.
- Difficulty starting urination.
- Slow prolonged urination.
- Increased urination frequency at night.
- Stopping and starting again while urinating.
- The feeling you can’t completely empty your bladder.
- Urinary tract infections.
- Inability to urinate.
Prevalence
- Men younger than 75 years of age with limited prostate cancer and who are expected to live at least 10 years more.
Diagnosis
Investigations Necessary
Doctors first try to establish that the prostate cancer has not spread beyond the prostate.
The above is determined by comparing the results of the biopsy and PSA results.
Further testing may include CT scan, bone scans, MRI scans and ultrasound.
If cancer has not spread the surgeon might offer other options besides surgery.
The other options could include radiation therapy, hormone therapy, or simple observation giving antibiotics.
- The above investigations will help the doctor to diagnose the disease.
- The above results will help the doctor to decide which of the above mentioned surgeries should be adopted to cure the problem.
- The high risk of cancer spread is observed , in such cases lymph node dissection may also be considered.
- The patient will be asked to fill an IPSS questionnaire.
- This is followed by a physical examination.
- Digital rectal examination, where he inserts his finger into the rectum to check for your prostate enlargement.
- Urine test follows to help rule out an infection or other conditions that can cause similar conditions.
- A blood test that can indicate kidney problems.
- Prostate Specific Antigen (PSA) blood test, the increased levels of which indicate an enlarged prostate.
- Urinary Flow Test wherein a machine is attached to the urethra to measure strength and flow of urine flow (Uroflowmetry and Urodynamics)
- Post-void residual volume test measures whether you empty your bladder completely. This test is done using ultrasound or by inserting a catheter into your bladder.
- 24-hour voiding diary which records the frequency and amount of urine.
Treamment
Hospice care and probable stay duration
● You will probably stay in the hospital for a few days after the surgery.
● The catheter will stay in place 1 or 2 weeks while you heal.
● You will be able to urinate on your own after the catheter is removed.
Pre-Surgery Preparation
● You need to bring an overnight bag for the necessary x-rays and medications you take regularly.
● Please ensure you bring all the paperwork provided to you by the concerned doctor.
Pre-surgery preparations
● Fasting is necessary for about 6 hours prior to the surgery since general anaesthesia or spinal anaesthesia is given.
● If you are a diabetic please inform the doctor.
● Bowels are to be cleared by you naturally or a microlax enema is given.
● Medications: your prescribed medications can be taken during the surgery except for blood thinners which need to be stopped.
● A blood test should be performed on the morning of the surgery to ensure that the blood is clotting appropriately.
● Anticoagulant medications should be ceased 5 days prior to the surgical procedure and not to be resumed until one to two weeks after the surgery.
● All natural therapy preparations must be stopped as they may interfere with the clotting ability of the blood.
● Please ensure the doctor in charge of the TURP surgery is aware of all the drugs, pills and medications you take whether you have a prescription or not.
Anaesthesia and Surgery
● In the operation theatre, the anaesthetist will take a medical history from you.
● He then decides whether you would be under general anaesthesia or spinal anaesthesia.
● In spinal anaesthesia, a needle is pricked on your spinal cord to avail numbness from waist down.
● In the case of general anaesthesia, you may be made to sleep for the duration of the operation.
● A combined visual and surgical instrument ( resectoscope ) is inserted through the tip of the penis and into the tube that carries urine from the bladder ( urethra ). The prostate surrounds the urethra, the doctor now trims the excess prostate tissue that is blocking urine flow.
Post Surgery
● You will be taken to the recovery room after surgery.
● Hospital staff will monitor your heart rate, breathing, oxygen levels and other vitals.
● The doctor will monitor closely for post-TURP syndrome which includes dizziness, headache, slow heartbeat, shortness of breath, seizures and even coma.
● A catheter is placed through your penis into your bladder until your prostate heels.
● Removal of extra prostate tissue should help you to urinate more easily and less frequently.
● Most men who have this surgery are back to their regular activities in 6 to 8 days.
- Do you have questions about Prostate Cancer?
- TELE CONSULT WITH YOUR UROLOGIST
Patient safety is our priority
Risks and complications
- While you recover you may have an urgent need to urinate.
- Trouble controlling urination.
- Pain during urination.
- Excessive bleeding, retrograde ejaculation and impotence.
- Urinary tract infections, chronic urinary problems, prostate regrowth or scarring in which case another surgery is suggested within 5 years.
- A split stream of urine caused by urethral narrowing.
- Allergic or abnormal reaction to anaesthesia.
- Hematospermia-This means blood (or sometimes clots ) in your sperm or ejaculate.
- Haematuria- Blood in urine which is a common side -effect since the urethra that transports urine from bladder to the penis goes through the prostate and will transport some blood into the urine.
- Infection. This is an extremely rare case as antibiotics would be administered to help prevent this infection.
- In case of infection you may suffer from fever or shivers in which case you have to intimate your doctor.
- Internal haemorrhage- This is a very uncommon condition, but if it occurs it may require a surgery.
- Urine retention- This may occur if the prostate is very enlarged and bleeding occurs within the prostate as a result of having biopsy. This bleeding may be a cause of blockage in the urethra which transports urine out of the bladder and passes through the prostate. This can lead to temporary inability to pass urine. This can be relieved by using a catheter to help you urinate.
- Erectile dysfunction (impotence).
- Formation of cysts containing lymph.
- Groin hernia.
What's important after discharge?
Tips for better recovery
● Stay hydrated with 8 to 10 glasses of water each day.
● Eating a healthy balanced diet.
● Avoid sexual intercourse for 1 or 2 months.
● Avoid lifting heavy items for 1 or 2 months.
● Limiting exercises that put a strain on the groin or lower abdominal area.
● Avoid stimulants such as caffeine, alcohol and nicotine.
● Limiting the use of over the counter drugs that can cause dehydration such as decongestants and antihistamines.
When to see a doctor
● Bleeding from urethra, outer prostate or penis.
● Inflammation and pain in the urethra, prostate or penis lasting longer than 2 weeks and worsening.
● Reduced urine flow or urine incontinence or urine urgency 6 weeks post surgery.
● Blood in urine even after 4 to 6 weeks after surgery.
● Severe clots of blood in urine or urine that is entirely red.
● Weakness or fatigue persists 4 weeks after surgery.
● Impotence or erectile dysfunction.
● Dizziness, shortness of breath.
● Severe or intensifying abdominal pain or discomfort.
- TELE CONSULT WITH OUR UROLOGIST