Radical Surgery For Prostate Cancer

Treating Advanced Prostate Cancer

If the cancer has reached an advanced stage, it’s no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.

Treatment options include:

• hormone treatment

If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.

Incision Of The Dorsal Venous Complex And Urethra

This is the final step of the dissection. Using a 0° lens with 1:3 scaling, the dorsal venous complex is incised tangentially to the prostate to avoid capsular incision. A plane between the urethra and dorsal venous complex is gently developed to expose the anterior urethral wall. The Foley catheter is reinserted and used to identify the anterior surface of the urethra at the urethroprostatic junction. The anterior wall of the urethra is transected with the scissors a few millimeters distal to the apex of the prostate .

The posterior wall of the urethra and the rectourethralis muscle are cut under direct vision. The freed specimen is then examined for adequacy of resection margins and is placed in a specimen-retrieval bag.

Certain Factors Affect Prognosis And Treatment Options

The prognosis and treatment options depend on the following:

• The stage of the cancer .
• The patients age.
• Whether the cancer has just been diagnosed or has recurred .

Treatment options also may depend on the following:

• Whether the patient has other health problems.
• The expected side effects of treatment.
• Past treatment for prostate cancer.
• The wishes of the patient.

Most men diagnosed with prostate cancer do not die of it.

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Prostate Cancer Treatment: Surgery

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Your surgeon will remove your prostate gland and some surrounding tissue, including the seminal vesicles. If cancer has spread to nearby nerves, your surgeon will also remove some or all of those nerves to make sure the cancer is gone.

What Are The Risks And Potential Complications Of Prostate Surgery

All surgical procedures have a risk of complications. The general risks of surgery include:

• Anesthetic reaction

• Bleeding, which can be extensive with some open procedures

• Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs causing a pulmonary embolism.

• Confusion or delirium from the anesthesia, particularly among older men

• Damage to nearby organs

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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.

There Are Three Ways That Cancer Spreads In The Body

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

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What The Research Shows About Radiation Vs Surgery

The ProtecT trial was a 10-year, randomized clinical study designed to compare radical prostatectomy, external-beam radiotherapy and active surveillance for the treatment of localized prostate cancer.

The results, published in 2016, showed that the rate of disease progression among men assigned to radiotherapy or radical prostatectomy was less than half the rate among men assigned to active monitoring. However, there was no significant difference in survival at the median 10-year follow-up for radiation therapy, surgery or active surveillance.

If youre interested in directly comparing treatment outcomes by treatment method and risk group , the Prostate Cancer Free Foundation provides an interactive graph on its website with information from data obtained from over 129,000 prostate cancer patients over a 15-year period.

As discussed earlier in the sections on the side effects of radiation therapy and surgery, the researchers conducting the ProtecT trial also looked at side effects and quality-of-life issues and found that the three major side effects of these two treatment options that affect quality of life after prostate cancer treatment are urinary incontinence, sexual dysfunction and bowel health.

The trial found that urinary leakage and erectile dysfunction were more common after surgery than after radiation therapy. Gastrointestinal bowel problems were more common after radiation therapy.

What Are The Risks Or Complications Of Radical Prostatectomy

• Urinary incontinence: Some people experience urinary incontinence, although most people recover continence. Your provider can help you manage loss of bladder control and urine leakage.
• Erectile dysfunction: Many people have problems maintaining erections after this surgery. The likelihood of recovery of erectile function depends on your erections before surgery and your surgeons ability to spare the nerves that control erection at the time of surgery. You may need to use erectile dysfunction medications or other treatments. The older you are, the more likely problems may occur.

There is also a small risk that you may experience:

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Radical Prostatectomy Cost In India

Oncology and Oncosurgery

Radical Prostatectomy Cost in India

Prostate cancer that has not been spread outside of the prostate gland is treated by radical prostatectomy. Radical prostatectomy can be open surgery or it could also be laparoscopic radical prostatectomy surgery, which can be assisted by a robot. Though complete recovery may take weeks or months, modest activity and medicine can assist in the healing process. After a prostate cancer diagnosis, a surgery of radical prostatectomy in India is done to remove the prostate gland and seminal vesicles . Patients with localized prostate cancer may benefit from it as a therapy option. Candidates for the procedure should be in good health and have a 10-year life expectancy.

Radical prostatectomy cost in India depends on the hospital, the doctors experience, and a variety of other factors, this cost may be lower or higher.

How Prostate Cancer Surgery Works

There are 2 ways a prostatectomy can be performed:

Laparoscopic radical prostatectomy :

Your surgeon will make 6 small cuts across your upper stomach. This can be done by hand or using a robotâusually the Da Vinci robot. The prostate will then be removed through one of the small cuts. This approach is considered minimally invasive and helps your doctor reduce damage and scarring to your abdominal wall.

Open radical prostatectomy

Your surgeon will make a cut below your belly button . Then, theyâll go in and remove the prostate from between the bladder and urethra.

The approach your surgeon takes can depend on many things but no matter which, the goal is always to safely and effectively remove the prostate gland and seminal vesicles. Itâs OK to ask your surgeon which approach is best for you, and itâs also OK to then ask how many surgeries your doctor has performed.

With either approach, your surgeon will try to avoid harming the nerves that run down the left and right side of the prostate . It can be hard to see these nerves during surgery, so your surgeon relies on their knowledge of the body to avoid harming them.

However, if your surgeon thinks cancer has reached the nerves, they will cut them on purpose to make sure the cancer is gone. It all really depends on where the cancer is and how far itâs spread. Your surgeon will discuss their plans with you before surgery and you can ask any questions you need to.

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Why The Procedure Is Performed

Radical prostatectomy is most often done when the cancer has not spread beyond the prostate gland. This is called localized prostate cancer.

Your doctor may recommend one treatment for you because of what is known about your type of cancer and your risk factors. Or, your doctor may talk with you about other treatments that could be good for your cancer. These treatments may be used instead of surgery or after surgery has been performed.

Factors to consider when choosing a type of surgery include your age and other medical problems. This surgery is often done on healthy men who are expected to live for 10 or more years after the procedure.

How Prostate Cancer Staging And Risk Group Affect Treatment Options

Your treatment choices are determined by several factors, including your cancers stage, aggressiveness and assigned risk stratification . Your age and current general health condition may also affect your choices.

Prostate cancer staging

Prostate cancer staging determines whether the cancer is confined to the prostate gland or whether theres evidence of metastasis, meaning its spread to other areas of the body.

Tools and methods to determine staging may include the prostate-specific antigen test, the digital rectal examination , the Gleason score and the American Joint Committee on Cancer TNM system, which provides information on the tumor, lymph node involvement and metastasis of a cancer. Imaging tests, such as a PET/CT scan, may also help determine your cancers stage.

The four stages of prostate cancer are subdivided into more precise categories, but we generally refer to three groups that indicate how far the cancer has spread:

• Localized: Theres no indication that the cancer has spread beyond the prostate.
• Regional: Theres evidence of cancer cells in nearby lymph nodes or tissue.
• Distant: Theres evidence the cancer has spread to other organs or body parts farther from the prostate.

Almost 90 percent of prostate cancers are diagnosed at the localized or regional stage. The five-year relative survival rate for men diagnosed with prostate cancer at these stages is nearly 100 percent.

Prostate cancer risk assessment

Treatment guidelines for prostate cancer

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Success Of Radical Prostatectomy

The goal of radical prostatectomy is to cure prostate cancer. But a prostate cancer cure is only possible from prostatectomy if your prostate cancer is limited to the prostate.

During radical prostatectomy, a member of your treatment team examines your removed prostate under a microscope to see if your cancer has reached the edge of the prostate. If so, the prostate cancer has probably spread. In these cases, you may need more treatments.

Men with no evidence of prostate cancer spread have an 85% chance of surviving 10 years after radical prostatectomy.

What Are The Types Of Radical Prostatectomy

Your surgeon will choose among several types of radical prostatectomy:

• Open radical prostatectomy: During this traditional type of surgery, your surgeon makes a vertical incision between your belly button and pubic bone. Your surgeon inserts tools through the incision to remove the prostate and surrounding tissue.
• Robot radical prostatectomy: Your surgeon makes several small incisions or one single incision across your abdomen. During the surgery, your surgeon operates state-of-the-art robotic controls outside your body. They can see the surgical area with a magnified view on a 3D screen.

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Can Surgery And Radiation Be Used Together

If both surgery and radiation are in the treatment plan for prostate cancer, surgery is usually done before radiation. Radiation may be given to the area around the prostate after removal to help reduce the risk of cancer returning.

This is often done proactively in people in whom staging after surgery shows high-grade disease with a high risk for recurrence.

Progression Of Laparoscopic Radical Prostatectomy

The first successful laparoscopic radical prostatectomies were performed by Schuessler in 1992 and 1997. Unfortunately, the technique did not gain widespread acceptance because of its extreme technical difficulty and because it offered no advantage over the criterion standard of open radical retropubic prostatectomy. The initial series reported operative times that ranged from 8 to 11 hours and a mean hospital stay of 7.3 days.

The laparoscopic approach gained new attention when 2 French groups published their experience with laparoscopic radical prostatectomy in 1999 and 2000. They reported modifications to the original technique, resulting in operative times that ranged from 4 to 5 hours and had a mean blood loss of 402 mL. The authors also reported a decreased mean hospital stay, due predominantly to earlier removal of the Foley catheter.

Even in the hands of these skilled laparoscopists, nerve-sparing dissection and construction of the urethrovesical anastomosis were demanding. With advances in medical technology, improved optics, and the widespread use of new laparoscopic instrumentation such as ultrasonic cutting and coagulating devices , laparoscopic radical prostatectomy began to gain acceptance and was increasingly performed in several high-volume centers worldwide. However, the technical demands of laparoscopic radical prostatectomy prevented its widespread use by the average urologist and thus limited penetration.

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How We Approach Prostate Cancer Treatment At Ctca

When you come to CTCA for a diagnostic consultation or second opinion, your case is reviewed by a multidisciplinary team of genitourinary cancer experts before you arrive for your first appointment. This care team may include a medical oncologist, a urologist or urologic oncologist and a radiation oncologist.

If we determine you need additional diagnostic evaluations, such as imaging or genomic testing, we schedule those procedures for you before your arrival.

Well also schedule appointments for you with our integrative care providers, who work to prevent and manage side effects of cancer and its treatment.

Together, we develop a treatment plan thats based on your unique needsusually within two to three days. Our goal is to give you and your caregivers a clear understanding of your options to empower you to make an informed decision about your care.

At CTCA, we strive to treat our patients as we would want our own loved ones to be treated: with compassion, dignity and respect. Its the basis of our foundation, and we call it the Mother Standard® of care.

What Happens During Radical Prostatectomy

You will have general anesthesia during your prostate surgery. Your surgical team inserts a catheter to drain urine.

After your surgeon removes your prostate, they check it under a microscope to see if cancer has extended beyond the edge of the prostate or into the seminal vesicles or lymph nodes. If it has, the cancer may have spread. In that case, you may need other treatment.

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Caring For The Incision

You will be able to take a shower the second day after your surgery. You may continue to have some discharge at the drain site for three to five days. Once you leave the hospital, the key words on caring for the drain site and incisions are clean and dry. Showering once a day and gently patting the area with a clean towel should be sufficient.

Robotic Radical Laparoscopic Prostatectomy Outperforms Open Surgery

• Under Prostate News

A results of a study recently published in ¹European Urology the official journal of the European Association of Urology compared the outcomes of localised prostate cancer patients who received either open surgery Retropubic Radical Prostatectomy or keyhole Robotic Radical Laparoscopic Prostatectomy the results reflected favourably on the latter.

During the controlled and methodical, retrospective study, 4003 patients provided post-op feedback via questionnaires, one, two and eight years after their operations which were performed between 2008-2011 throughout fourteen Swedish clinics .

Despite both short and long-term data from either RRP or RALP showing insignificant change where urinary incontinence was concerned, the study did confirm it was the primary patient outcome. The post-op feedback gathered also provided further insight, finding that far fewer RALP patients experienced ED following their procedures.

PCSM rates amongst RALP patients were also found to be lower . As well as proving the minimally invasive RALPs to be oncologically safe, their potential to provide prostate cancer treatment specialists with wider functionality during operations was also recognised.

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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.

Brachytherapy For Prostate Cancer

Brachytherapy is a form of internal radiation therapy. With this type of therapy, radiation is delivered to the prostate tumor inside the body via a catheter or another implantable device.

High-dose rate brachytherapy uses radioactive Iridium-192 to deliver high doses of radiation to the prostate tumor. Treatments are short, sometimes requiring as few as five sessions. Brachytherapy radiation more tightly surrounds the tissues were targeting, which may help spare normal tissues.

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Risks Of The Procedure

As with any surgical procedure, certain complications can occur. Somepossible complications of both the retropubic and perineal approaches to RPmay include:

Some risks associated with surgery and anesthesia in general include:

• Reactions to medications, such as anesthesia

• Difficulty with breathing

One risk associated with the retropubic approach is the potential forrectal injury, causing fecal incontinence or urgency.

There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your doctor prior to the procedure.