What Are The Side Effects
Initially, the urethra and surrounding area will be inflamed, and it will be difficult to urinate. The catheter and flushing process can also be uncomfortable and cause bladder cramping.
The urethra, penis, and lower abdominal area will be tender, red, and swollen for a few weeks after surgery, which can interfere with urination. Most people also feel very weak and tire easily for several weeks.
Common side effects of TURP surgeries include:
- difficulty completely emptying the bladder
- urinary urgency or the sudden urge to urinate
- discomfort during urination
- small dribbles or clots of blood in the urine, for up to 6 weeks
The minor side effects associated with TURP surgeries usually go away as the urethra and prostate tissues become less inflamed, usually within a few weeks.
Though TURP surgeries may or may not be associated with erectile difficulty in some people, they can decrease the volume of semen produced during ejaculation.
As with any medical procedure, especially those involving anesthesia, the surgery for BPH is associated with some medical complications.
Possible but rare risks associated with TURP procedures include:
- excessive bleeding
Baus Radical Prostatectomy Audit
The British Association of Urological Surgeons now publishes the results of radical prostatectomy for surgery performed in the UK. Details of the operations performed by each surgeon and centre are given, with information about the technique used, transfusion rates, postoperative complications and length of stay for individual surgeons and units. The responsibility of entering the data, however, lies with the individual surgeons and is not always complete.
Open Radical Prostatectomy Vs Minimally Invasive Radical Prostatectomy
In 2003, only 9.2% of radical prostatectomies were done using a minimally invasive procedure. By 2007, that number had jumped to 43.2%. In 2009, researchers in Boston reported on a study that compared outcomes, benefits, and complications of open surgery vs. minimally invasive surgery:
- No difference was found in deaths or in the need for additional cancer therapy between the two approaches.
- The median hospital stay was two days for minimally invasive surgery and three days for open surgery.
- 2.7% of men having laparoscopic surgery required a blood transfusion compared with 20.8% of men having open surgery.
- There was more anastomotic stricture — narrowing of the suture where internal body parts are rejoined — for open surgery than for minimally invasive surgery .
- There were fewer respiratory complications with minimally invasive surgery than with open surgery .
- There were lower rates of incontinence and erectile dysfunction with open surgery. The overall rate was 4.7% for laparoscopic surgery and 2.1% for open surgery.
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What To Do If You Are Diagnosed With Prostate Cancer
If you re diagnosed with prostate cancer, understand what your Gleason score is, how much cancer you have, and then we will look at options.
The main surgical treatment that we are offering to patients is called robotic surgery. You may know it as Da Vinci robotic surgery.
This is a minimally invasive surgery I have devoted my whole carrier to. Over the last 2 decades, I have done over 7 thousand of these operations with superb outcomes. These outcomes are: less blood loss, faster recovery, excellent sexual function, urinary control is superb and with time it gets better. We certainly can discuss this option with you.
This surgery typically takes about one hour and a half. There is no incision, key-whole openings will bring in these fine instruments, and with magnification, better lighting, and maneuvering around the prostate we are able to do a beautiful nerve-sparing. This not only cures them from cancer but also improve their quality of life, which is also important.
I hope that you study this. If you have questions about anything related to elevated PSA or mens health, send them to me. I encourage women out there to ask their boyfriends or husbands:
- Do you know what your PSA is?
- Why are getting up in the middle of the night?
- Do you know what your testosterone level is?
- Why are you not interested in sex?
All of these play a big role.
If have been diagnosed with prostate cancer, ! I am happy to give a second opinion.
Surgically Removing The Prostate Gland
A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.
Like any operation, this surgery carries some risks.
A recent trial showed possible long-term side effects of radical prostatectomy may include an inability to get an erection and urinary incontinence.
Before having any treatment, 67% of men said they could get erections firm enough for intercourse.
When the men who had a radical prostatectomy were asked again after 6 months, this had decreased to 12%. When asked again after 6 years, it had slightly improved to 17%.
For urinary incontinence, 1% of men said they used absorbent pads before having any treatment.
When the men who had a radical prostatectomy were asked again after 6 months, this had increased to 46%. After 6 years, this had improved to 17%.
Out of the men who were actively monitored instead, 4% were using absorbent pads at 6 months and 8% after 6 years.
In extremely rare cases, problems arising after surgery can be fatal.
It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.
After a radical prostatectomy, you’ll no longer ejaculate during sex. This means you will not be able to have a child through sexual intercourse.
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The Bicalutamide Early Prostate Cancer Program
The experience with adjuvant tamoxifen therapy in early breast cancer provides a rationale for examining adjuvant antiandrogen therapy in early prostate cancer. The bicalutamide EPC program is an international trial program initiated to explore the benefits of bicalutamide once daily as adjuvant therapy to standard care of radical prostatectomy, radiotherapy, or watchful waiting in patients with early prostate cancer. The program comprises three ongoing, randomized, double-blind, placebo-controlled clinical trials and involves over 8000 men the primary endpoints are time to objective progression and overall survival. Approximately 55% of the patients in the program received radical prostatectomy as primary therapy, whereas about 18% received radiotherapy. It is hoped that the results of this trial program, the largest to date in prostate cancer treatment, will determine the role of adjuvant therapy with antiandrogens in early prostate cancer.
Strengths And Limitations Of The Study
This study had two major strengths it is a population wide study evaluating 15 year quality of life outcomes in men with localised prostate cancer across a range of different common treatments and includes a population based control group of men without prostate cancer for comparison. A major advantage of using a population based control group is that it allows men to quantify their expected decline in quality of life resulting from the combination of their cancer and its treatment choice, while also allowing them to indirectly compare quality of life difference between treatments . A few limitations need to be considered, however, when interpreting our results.
Firstly, we considered it important to use men without prostate cancer as controls in order to provide the most meaningful comparator for patients with prostate cancer and clinicians, and therefore we were unable to adjust for disease severity in the multivariate analysis . Nevertheless, we believe that this choice of reference group had little association with our findings as a sensitivity analysis indicated that clinical stage, Gleason score, and prostate-specific antigen level at baseline did not appreciably confound the association with treatments .
Fourthly, although we adjusted for a wide range of potential confounders to account for differences in patient characteristics between groups, as with all non-randomized studies, the possibility of residual confounding cannot be ruled out.
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Radical Prostatectomy Prolongs Life Expectancy Of Men With Prostate Cancer
Bill-Axelson A, et al. N Engl J Med. 2018 doi:10.1056/NEJMoal807801.
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Men with clinically detected, localized prostate cancer and long life expectancies gained an average of 2.9 years of life after undergoing radical prostatectomy, according to a randomized study published in The New England Journal of Medicine.
Researchers also found that high Gleason scores and the presence of extracapsular extension in the radical prostatectomy specimens were highly predictive of death of prostate cancer.
Radical prostatectomy reduces mortality among men with clinically detected localized prostate cancer, but evidence from randomized trials with long-term follow up is sparse,Anna Bill-Axelson, MD, PhD, of the department of surgical sciences at Uppsala University, and colleagues wrote. The strengths of our trial are the randomized design, the completeness of the long-term follow-up data, and the blinded evaluation of causes of death.
Researchers randomly assigned 695 men with localized prostate cancer all of whom were aged younger than 75 years, had a life expectancy of at least 10 years, and had no other known cancer that could shorten survival to watchful waiting or a radical prostatectomy between 1989 and 1999. All men had PSA levels lower than 50 ng/mL.
Death of any cause, death of prostate cancer and metastasis served as study endpoints.
Prostate Cancer Treatment Options For Low
Well, if you have low-risk prostate cancer, something called watchful waiting or closed surveillance would be a very good option. Close surveillance means that you would be coming every 3 months for a check-up. We would be looking at your PSA and we would be examining you. Every other year we will make an MRI or a biopsy to make sure that the cancer is not advanced. This is for people who are compliant, they have low-risk prostate cancer, they may be older and they may have a lot of co-morbidities that w may not want them to be too aggressive.
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Sexual Function And Bother
Sexual function scores in men treated for localised prostate cancer were lower than in population based controls for all treatment groups at all follow-up time points and in unadjusted absolute terms . All treatment groups exceeded the threshold for clinically significant change at 15 years relative to controls . The two prostatectomy surgery groups had the worst sexual function scores relative to controls . Adjusted mean differences were respectively 42.1, 95% confidence interval 44.9 to 39.3 and 47.0, 49.6 to 44.4 at year 1, and 19.9, 26.0 to 13.8 and 24.7, 30.8 to 18.7 at year 15. Sexual function scores for each group receiving active treatment generally showed an initial sharp decline from baseline to year 1 , and gradual improvement thereafter in comparison with controls . Exceptions to this generality were men on active surveillance/watchful waiting who reported an initial decline up to year 2 with a plateau thereafter men treated with external beam radiation therapy/high dose rate brachytherapy, who reported little recovery in sexual function across the whole 15 year period and the group receiving low dose rate brachytherapy who, after initial improvement, reported a decline in erectile dysfunction score after year 5 .
Prevalence of men with localised prostate cancer and of control men who reported incontinence, bowel problems, or impotence at 15 years by initial treatment
Radical Prostatectomy Survival Rates
Men who undergo radical prostatectomy have a high survival rate and low rates of cancer recurrence, cancer spread and death, according to a study of 10,332 men who had surgery between 1987 and 2004. The research showed that between 5 and 20 years after having the surgery, only 3% of the patients died of prostate cancer, 5% saw their cancer spread to other organs, and 6% had a localised recurrence.
Another large Scandinavian study compared men who chose active surveillance with those treated by radical prostatectomy. The results suggest that in the long term, younger men with higher-risk tumours who have a radical prostatectomy, have a definite survival advantage.
Results from another study at Johns Hopkins Hospital in Baltimore confirmed that 82% of men undergoing radical prostatectomy were free of recurrence at 15 years. The data from the research also indicated that in those men whose PSA level starts to rise again after surgery, the recurrent prostate cancer spreads in only around one-third of the men. In addition, unless a man had an aggressive grade of prostate cancer, the spreading of the disease would not become life-threatening for several years and would be amenable to treatment.
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When You Meet With Patients Who Have Opted For Prostate Cancer Surgery What Complications Seem To Cause The Most Anxiety
Patients are usually concerned about longer-term quality-of-life issues, such as urinary control also called urinary continence and changes in sexual function. Prostate cancer surgery does sometimes have a negative impact on these functions, although the likelihood depends on a variety of factors, including age, the extent of the cancer, and baseline function, or how well everything worked before the procedure.
The outcomes for urinary continence at MSK are what I would consider to be excellent. More than 90 percent of our patients will regain urinary control, although they may go through a period perhaps several months or a year after surgery in which they do not have complete control.
For sexual function, the extent of recovery is especially affected by the nature of the cancer. Unfortunately, the nerve tissue that allows a man to get an erection is right up against the prostate. We obviously want to remove all the disease, and if the cancer extends outside the prostate at all, its not wise for us to try to preserve the nerve tissue because we might leave some cancer behind.
You often see claims made by institutions or surgeons that the patients they treat recover their erectile function in 90 percent of cases. Thats true only for a very select group of patients, usually those who are younger and had full erections prior to surgery.
The Main Advantage Of Prostatectomy
This is a very important comment I am gonna make right now. If your cancer ever comes back after surgery, the idea of having a plan B of having low-dose radiation after surgery is feasible. If you start with radiation and cancer comes back, surgery would be very difficult and challenging. So, I want you to know this because not too many people are aware of this.
Again, one more time. If you start with surgery, you still have the radiation as an option. If you start with radiation, surgery would be very difficult because the tissue becomes like a cement attached to the rectum and the surrounding tissues and it would be very difficult to do that operation.
As you get older, because we have removed the prostate with the surgery, you do not have to worry about the old-man disease, an enlarged prostate. With radiation may be some consequences with bleeding from the rectum or bleeding from the bladder. Certainly, in the hands of an experienced radiation oncologist, the results are better. We have superb doctors at St. Francis Hospital. One of my colleagues, Dr. Jay Bosworth, whom I am looking forward to interviewing him at this program, is a fine radiation oncologist and you will have what to learn from him. So, the risks of side-effects in the hands of an experienced radiation oncologist would be less. But there is a small chance of having secondary cancers such as rectal cancer or bladder cancer at some point down the road after radiation.
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What Are The Treatments For Localized Prostate Cancer
- Surgery takes out the prostate and any nearby tissue that may contain cancer, including lymph nodes. This surgery is called a radical prostatectomy . A doctor can do it as open surgery by making a cut, or incision, in your belly or groin. Or he or she can do laparoscopic surgery by putting a lighted tube, or scope, and other surgical tools through much smaller cuts in your belly or groin. The doctor is able to see your prostate and other organs with the scope. In some places, robot-assisted laparoscopic prostatectomy may be done. In this type of surgery, the surgeon controls the robotic arms that hold the tools and scope.
- Radiation uses X-rays and other types of radiation to kill the cancer cells. This may be done with:
- External-beam radiation, in which a machine aims high-energy rays at the cancer.
- Brachytherapy , in which tiny pellets of radioactive material are injected into or near the cancer.
- Both kinds of radiation.
Radiation and surgery are treatments that destroy or remove localized prostate cancer. Both treatments also have long-term side effects, like bladder, bowel, and erection problems.
In the first 2 to 5 years after treatment, the chance of having erection or bladder problems is higher with surgery. And the chance of having bowel problems, such as an urgent need to move your bowels, is higher with radiation. But at 15 years, the chance of erection, bladder, or bowel problems is about the same with either treatment.footnote 3
Which Treatments Are Best In Keeping Men In Remission
Here is your opportunity to compare prostate cancer treatments. Over 129,000 patients underwent PSA monitoring after treatment to see which treatments were most effective at keeping the cancer in remission. The charts show which treatments are more likely to leave patients Prostate Cancer Free, for how many years. Share this data, talk with your Doctor, or multiple Doctors and make an informed decision. Select the treatment option, that is best for you.
Compare Prostate Cancer Treatments by gathering information about your own Prostate Cancer Diagnosis. Your Doctor will provide three elements that describe your prostate cancer. Your PSA, Stage and Gleason Score. These three elements help you determine your risk group. Find and select your Risk Group in the table below. This will take you to the comparing prostate cancer treatments page, where you can select different prostate cancer treatments on an interactive chart and graphically see their effectiveness over time.
The treatments included in this study are Prostate Surgery or Prostatectomy, , Brachytherapy or Seeds, High Dose Rate Radiation, HDR, External Beam Radiation Therapy or EBRT, Androgen Deprivation Therapy, ADT, or Hormone Treatment, Proton Therapy, High-Intensity Focused Ultrasound, HIFU, Cryotherapy, Cryo and Hypo-Fractionated External Beam Radiation Therapy. For more advanced prostate cancer, treatments are combined to increase effectiveness.
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