Prostate cancer surgery, also known as a radical prostatectomy, involves removing the entire prostate gland along with the cancer cells inside it. The goal is to eliminate the cancer while minimising side effects.
Who Can Have Prostate Cancer Surgery?
Localised Prostate Cancer
- Eligibility: Suitable for men whose cancer has not spread beyond the prostate and who are in good health.
- Alternative Treatments: Options include active surveillance or external beam radiotherapy. Studies indicate that men with low-risk localised prostate cancer who choose any of these treatments have similar chances of living for ten years or more.
Locally Advanced Prostate Cancer
- Eligibility: May be suitable for men whose cancer has spread just outside the prostate. The suitability depends on how far the cancer has spread.
Recurrent Prostate Cancer
- When Used: Can be used if cancer returns after radiotherapy, though this is rare due to the higher risk of side effects such as urinary incontinence or erectile dysfunction.
Advanced Prostate Cancer
- Eligibility: Generally not an option unless part of a clinical trial.
What Types of Prostate Surgery Are Available?
Robot-Assisted Keyhole Surgery
- Procedure: Involves making small incisions and using robotic arms controlled by a surgeon to remove the prostate.
- Benefits: Less blood loss, reduced pain, shorter hospital stay, and quicker recovery.
- Availability: Not available in all hospitals due to the need for specialised equipment.
Open Surgery
- Procedure: Involves making a single large incision in the lower abdomen.
- When Used: Preferred when robotic surgery is not an option.
What are the Advantages and Disadvantages of Surgery?
Advantages
- Complete Removal: If cancer is confined to the prostate, surgery can remove it entirely.
- Post-Surgery Analysis: Provides a detailed understanding of cancer's aggression and spread.
- PSA Levels: A significant drop in PSA levels post-surgery indicates successful removal.
- Further Treatment: Additional treatment options are available if needed.
Disadvantages
- Surgery Risks: Includes bleeding, infection, and blood clots.
- Side Effects: Urinary incontinence and erectile dysfunction are possible.
- Recovery: Requires a hospital stay (1-5 days).
What are the Risks of Surgery?
- Bleeding: Rare in keyhole surgery (less than 1%).
- Injury: Possible damage to nearby tissues and organs.
- Blood Clots: Less than 2%.
- Infection: About 1-5%.
- Scarring: Where incisions are made.
- Anaesthetic Complications: Serious issues are rare.
How to Prepare for Surgery?
Before the Operation
- Pre-op Assessment: Includes blood tests, ECG, physical examination, and scans.
- Pelvic Floor Exercises: May aid recovery from urinary problems.
Getting Organised at Home
- Preparation: Stock up on food, arrange help for daily tasks, and prepare for rest.
What Does the Surgical Procedure Involve?
During the Operation
- Anaesthetic: General anaesthetic is used.
- Duration: Typically lasts 2-4 hours.
- Procedure: Removal of the prostate and seminal vesicles. Nerve-sparing techniques may be used to preserve erectile function.
After the Operation
- Recovery: Initial recovery in the hospital with an oxygen mask and IV fluids.
- Catheter: Used to drain urine while healing.
What to Expect When Going Home?
Catheter Care
- Hygiene: Proper handling to prevent infections.
- Removal: Typically 1-3 weeks post-surgery.
Managing Pain and Swelling
- Pain Relief: Provided post-surgery.
- Swelling: Common but should subside within weeks.
Post-Operative Care
- Activity: Gradual return to normal diet and activities.
- Avoid Strenuous Activities: For about eight weeks.
What Monitoring and Follow-up after radical removal of the prostate.
- PSA Tests: Regular tests to monitor for cancer recurrence.
- Healthcare Contact: Maintain contact with healthcare providers for any unusual symptoms.
Reflection on radical prostatectomy
Radical prostatectomy is a significant operation but can effectively treat prostate cancer confined to the prostate. It requires careful preparation and post-operative care to ensure successful recovery and monitoring for potential recurrence.
