Different Types Of Prostate Cancer Surgery

So Why Would You Go See The Doctor

An important clinical goal for you and your doctor should be to detect risk for prostate cancer long before it can cause symptoms.

Thus, any initial detection of signs that you may have prostate cancer is now most commonly the result of a regular check-up carried out by your primary care physician, which may include a digital rectal examination or a prostate specific antigen test.

The most common symptom which may make a man go to either his primary care physician or a urologist, and which might subsequently lead to a diagnosis of prostate cancer, is some form of problem with normal urination.

Since all the symptoms listed above may be caused by prostate cancer and/or by a number of other disorders , it would be wise to talk to your family doctor if you or someone else in your family is having one or more of these problems on a regular basis.

Prostate Cancer Risk Groups

Prostate cancer can be categorised into one of 5 risk groups in the Cambridge Prognostic Group .

Doctors will look at the Grade Group , prostate specific antigen level and tumour stage to decide which CPG group the prostate cancer is.

The risk group of the cancer will help determine which types of treatments will be necessary.

If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.

Side Effects Of Hormone Therapy

Hormone therapy may cause side effects associated with low testosterone, such as hot flashes, sweating, weight gain, reduced sexual desire and depression. Some men also may experience swollen breasts, depression, memory loss and heart problems. Eventually, the cancer may become resistant to hormone therapy. If hormone therapy stops working, doctors may switch treatments.

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Side Effects Of Targeted Therapy

Some men may experience side effects such as diarrhea, nausea and low red blood cell counts. Other possible side effects include:

Liver blood tests may also be abnormal.

One of the targeted therapies for prostate cancer, Lynparza® , may increase the risk for blood clots in the lungs and legs. These drugs may also cause a blood cancer such as myelodysplastic syndrome or acute myeloid leukemia, but this is rare.

Common Side Effects Of Prostate Surgery

There are three main complications associated with prostate surgery: urinary problems, erectile dysfunction and sexual dysfunction.

With radical surgery for cancer, there is usually a period of incontinence that resolves within a few months. Therefore, pelvic floor exercises with a physio are essential before surgery. However, it can take several months for the incontinence to resolve, even with robotic surgery.

In severe cases, further surgery may be needed to treat incontinence. Erectile dysfunction is also a common side effect of cancer surgery and may take up to 12 months to improve. In some patients, normal function may never return. It is dependent on the preop function and the degree of nerve-sparing that can be performed .

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How To Choose Between Different Types Of Prostate Cancer Surgery

I frequently see patients who have been diagnosed with prostate cancer, have decided on surgery, but are struggling with the choice of different types of surgery. Increasingly, there can be a choice, especially if patients seek opinions from two or three different urologists . A common scenario might be: the patient sees a doctor who argues robotic prostate cancer surgery is superior to other approaches. He might see another specialist who argues that a laparoscopic prostatectomy remains the gold standard the best minimally invasive approach. A third consultant might advise him that his best chance of maintaining his usual erections would be open surgery. Who to believe?

The only way to understand this variety of approaches and the marketing behind them is to look at how they each developed. In the UK, up until 2000, the only prostatectomy on offer was via open surgery. Thereafter, a small number of surgeons, myself included, started to carry out prostatectomies using a laparoscopic approach. The number of surgeons was relatively small because this is a technically difficult operation to perform. Compared with, for example, removing a gall bladder, reaching and safely removing a prostate laparoscopically is very challenging. However, I felt there were clear benefits of keyhole surgery for patients in terms of post-operative recovery and performed many hundreds of laparoscopic operations.

Types Of Prostate Surgery

There are several different approaches to prostate cancer surgery and they can be performed in a variety of ways. The type and extent of your surgery will depend on how aggressive your cancer is and whether it has spread beyond your prostate.

Radical prostatectomy is when your surgeon removes the whole prostate gland. If cancer has spread, your surgery may extend beyond your prostate and include the surrounding lymph nodes.

There are several types of surgery available when you need to have your prostate gland cut, partially removed or removed, each with its own benefits.

Open retropubic surgery

Your surgeon makes a 10cm incision in your abdomen, then removes the entire gland. If you have very aggressive prostate cancer, some of the surrounding lymph nodes may also be removed for testing. Your surgeon may not continue the surgery if they discover that your cancer has already spread.

Keyhole surgery

Your surgeon accesses your prostate gland by inserting instruments through several small incisions in your abdomen. Keyhole prostate surgery is usually done robotically: miniature robotic arms, controlled by your surgeon, are inserted through the incisions. It has similar benefits to traditional non-robotic surgery, but the procedure tends to cost more because of substantial out-of-pocket costs from your surgeon.

Nerve-sparing surgery

Other surgeries for prostate cancer

Open perineal surgery

Which is the best type of surgery?

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Side Effects Of Chemotherapy

• Digestive issues such as nausea, vomiting and diarrhea

While on chemotherapy, patients are also susceptible to infections because their white blood cell counts are lower. Other common side effects include bruising or bleeding due to fewer blood platelets and fatigue due to the lowered red blood cell count.

Its also possible to experience a severe allergic reaction to some of the drugs used to treat prostate cancer, especially Taxotere® and Jevtana® . The patients care team may recommend medicines before each session to help prevent a reaction.

The prostate chemotherapy drug mitoxantrone may cause leukemia later in life, but this is rare. The prostate chemotherapy drug Emcyt® may increase the risk for blood clots.

During chemotherapy, doctors may also offer supportive care services to help ease side effects. For example, naturopathic providers may suggest supplements to reduce nausea. Also, a mind-body therapist may recommend techniques to help the patient relax and feel less anxious during prostate cancer chemotherapy treatments.

Prostate Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Prostate

The prostate is agland in the malereproductive system. It lies just below the bladder and in front of the rectum . It is about the size of a walnut and surrounds part of the urethra . The prostate gland makes fluid that is part of the .

Prostate cancer is most common in older men. In the U.S., about 1 out of 8 men will be diagnosed with prostate cancer.

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Transurethral Resection Of The Prostate

A transurethral resection of the prostate abbreviated as TURP is another operation to treat BPH symptoms by removing blockages to urine flow.

Rather than using a laser, the procedure employs a resectoscope into the urethra to get a visual of the prostate tissue and the lining of the bladder. Using the resectoscope, the urologist can trim away enlarged lobes of the prostate. The capsule of the prostate is left intact. This uses electricity as an energy source rather than laser energy.

/6what Are The Factors That Can Put You At Risk

While the cause for prostate cancer is not clearly known, there are several factors that can increase your chances of developing the disease:

Age: Your risk of prostate cancer rises as you grow older. The disease gets more common for people above 80 years.

Family history: If a blood relative already has prostate cancer, then you are at a higher risk of developing the cancer due to similar genes.

Obesity: Being obese put you at a higher risk of prostate cancer. Further, the cancer is more likely to be aggressive for those who are obese.

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What Are The Side Effects

The most common side effects of surgery are leaking urine and problems with getting or keeping an erection .

Your risk of getting these side effects depends on your overall health and age, how far the cancer has spread in and around the prostate and how likely it is to grow, and your surgeons skill and experience.

Types Of Prostate Cancer Surgery

Traditional prostate removal surgery is referred to as radical prostatectomy, during which prostate gland is removed surgically under the influence of general anesthesia. Next to skin cancer the prostate cancer is the most common cancer type reported in America. Based on how aggressive it is, it is classified into 4 stages:

• Stage1: In this stage, the cancer is localized and is smaller in size.
• Stage 2: In this stage, the cancer remains localized but becomes larger in size.
• Stage 3: In this stage, the cancer breaks into seminal vesicles and is referred to as locally advanced cancer.
• Stage 4: In this advanced stage, the cancer becomes metastatic i.e. it spreads to nearby parts of the body such as bladder, rectum or lymph nodes.

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Treatment Options For Advanced Prostate Cancer

Its rare for prostate cancer to metastasize, or spread to other parts of the body. In about 90 percent of all cases, this type of prostate cancer is diagnosed in its early stages, when the disease is confined to the prostate. However, when the disease metastasizes, prostate cancer cells tend to spread to the brain, bones, lungs and liver. Metastatic prostate cancer cells may also be found in lymph nodes outside the pelvis.

In some cases, the treatment options for advanced prostate cancer may be considered palliative, used to relieve symptoms and improve quality of life. Treatment options include:

Prognosis For Prostate Cancer

It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person’s individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of prostate cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.

Prostate cancer often grows slowly and even more aggressive types tend to grow more slowly than other types of cancer. If diagnosed early, prostate cancer has one of the highest five year survival rates.

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Active Surveillance And Watchful Waiting

If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.

Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.

ASCO encourages the following testing schedule for active surveillance:

• A PSA test every 3 to 6 months

• A DRE at least once every year

• Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years

Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.

Making Decisions About Surgery

Talk to your surgeon about the surgical methods available to you. Ask about the advantages and disadvantages of each option. There may be extra costs involved for some procedures and they are not all available at every hospital. You may want to consider getting a second opinion about the most suitable type of surgery. See more about Making treatment decisions.

The surgeons experience and skill are more important than the type of surgery offered. Compared to open surgery, both standard laparoscopic surgery and robotic-assisted surgery usually mean a shorter hospital stay, less bleeding, a smaller scar and a faster recovery. Current evidence suggests that the different approaches have a similar risk of side effects and no difference in long-term outcomes.

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Changes You Shouldnt Ignore

Early-stage prostate cancer rarely causes symptoms but as the disease progresses, you may experience certain warning signs. Knowing the signs of prostate cancer will help you keep an eye out for any concerning changes to your health.

Keep in mind, though, these symptoms dont indicate trouble with your prostate, Dr. Weight says. In fact, almost all of them come standard with aging. But if you experience several symptoms or have other concerns, it may be a good idea to visit a urologist.

Open Or Laparoscopic Radical Prostatectomy

In the more traditional approach to prostatectomy, called anopen prostatectomy, the surgeon operates through a single long skin incision to remove the prostate and nearby tissues. This type of surgery is done less often than in the past.

In a laparoscopic prostatectomy, the surgeon makes several smaller incisions and uses special long surgical tools to remove the prostate. The surgeon either holds the tools directly, or uses a control panel to precisely move robotic arms that hold the tools. This approach to prostatectomy has become more common in recent years. If done by experienced surgeons, the laparoscopic radical prostatectomy can give results similar to the open approach.

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Urinary Problems After Surgery

Leaking urine

Most men cant control their bladder properly when their catheter is first removed. This is because surgery can damage the muscles and nerves that control when you urinate.You might just leak a few drops if you exercise, cough or sneeze . Or you might leak more and need to wear absorbent pads, especially in the weeks after your surgery.Leaking urine usually improves with time. Most men start to see an improvement one to six months after surgery. Some men leak urine for a year or more and others never fully recover, but there are things that can help and ways you can manage it.

Difficulty urinating

A few men may find it difficult to urinate after surgery . This can be caused by scarring around the opening of the bladder or the urethra .Some men find they suddenly and painfully cant urinate. This is called acute urine retention and it needs treating quickly to prevent further problems. If this happens, call your doctor or nurse, or go to your nearest accident and emergency department.

Watch Paul’s story for one man’s experience of managing urinary problems after surgery below.

What Are Some Common Signs And Symptoms Of Prostate Cancer

When it comes to the signs and symptoms of prostate cancer, theres both good news and bad news. Lets get the bad out of the way first: Prostate cancer does not make its presence known in an obvious manner until it has progressed significantly.

That means you may be quite ill by the time you notice that theres something wrong. In such situations, the prognosisor, how successful treatment is likely to beis often not as hopeful as youd want it to be. That said, heres the good news to keep in mind: Many of the clues below can be traced to other, less serious health conditions. You should never ignore them, but you should also know they dont automatically mean you have cancer.

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Side Effects Of Prostate Surgery

The major possible side effects of radical prostatectomy are urinary incontinence and erectile dysfunction . These side effects can also occur with other forms of prostate cancer treatment.

Urinary incontinence: You may not be able to control your urine or you may have leakage or dribbling. Being incontinent can affect you not only physically but emotionally and socially as well. These are the major types of incontinence:

• Men with stress incontinence might leak urine when they cough, laugh, sneeze, or exercise. Stress incontinence is the most common type after prostate surgery. It’s usually caused by problems with the valve that keeps urine in the bladder . Prostate cancer treatments can damage this valve or the nerves that keep the valve working.
• Men with overflow incontinence have trouble emptying their bladder. They take a long time to urinate and have a dribbling stream with little force. Overflow incontinence is usually caused by blockage or narrowing of the bladder outlet by scar tissue.
• Men with urge incontinencehave a sudden need to urinate. This happens when the bladder becomes too sensitive to stretching as it fills with urine.
• Rarely after surgery, men lose all ability to control their urine. This is called continuous incontinence.

After surgery for prostate cancer, normal bladder control usually returns within several weeks or months. This recovery usually occurs slowly over time.

There are several options for treating erectile dysfunction: