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What To Expect After Prostate Cancer Surgery

What To Expect After Radiation Treatment For Prostate Cancer

What to Expect After Prostate Cancer Surgery
  • Cancer Treatment Expert

What to Expect After Radiation Treatment for Prostate Cancer? Many patients wonder what to expect after receiving radiation treatment for prostate cancer. It is the most widely used method of treatment regardless of the cancers stage. Radiation therapy can be followed by a radical prostatectomy, which removes the prostate gland and nearby lymph nodes.

Prostate cancer is the most diagnosed solid tumor type among men. In the early stages ofprostate cancer, indolent cases without major symptoms will receive activesurveillance and watchful waiting to observe how the disease progresses. If thecancer spreads outside of the prostate gland, other treatment options areconsidered, the first of which being radiation.

What To Expect After Prostate Laser Surgery

Laser surgery is an increasingly widely-used technique in men who were diagnosed with benign prostatic hyperplasia, an enlargement of the prostate that occurs in most men, to some degree, with age. Compared to traditional prostate surgery methods, prostate laser surgery has some distinct advantages. They include a lower risk of serious post-surgery bleeding, a much shorter hospital stay or the possibility of being treated on an outpatient basis, a significantly reduced need for a urinary catheter, and a much quicker recovery.

Nonetheless, prostate laser surgery, though delivered through concentrated beams of light that either vaporize or cut off excess prostate tissue rather than with a scalpel, is surgery. All forms of surgery carry some degree of risk, and all forms of surgery depend on you the patient to follow the appropriate aftercare guidelines delivered by your surgeon to the letter.

How Long Does It Take To Recover From Prostate Surgery

Depending on the type of surgery the recovery time after prostate surgery may linger up to several months. This length refers to a complete healing process. Patients may feel better the very day after the surgery but they need to realize that their body will fully recover only after certain period of time.

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What Is Prostate Removal

A prostatectomy is a surgical procedure for the partial or complete removal of the prostate, which is a small gland about the size of a ping-pong ball, located deep inside the groin, between the base of the penis and the rectum in men. The prostate supplies part of the seminal fluid , which mixes with sperm from the testes. Sperm needs this fluid to travel and survive for reproduction.

Transurethral Resection Of The Prostate

What to Expect After Prostate Cancer Surgery

This operation is more often used to treat men with non-cancerous enlargement of the prostate called benign prostatic hyperplasia . But it is also sometimes used in men with advanced prostate cancer to help relieve symptoms, such as trouble urinating.

During this operation, the surgeon removes the inner part of the prostate gland that surrounds the urethra . The skin is not cut with this surgery. An instrument called a resectoscope is passed through the tip of the penis into the urethra to the level of the prostate. Once it is in place, either electricity is passed through a wire to heat it or a laser is used to cut or vaporize the tissue. Spinal anesthesia or general anesthesia is used.

The operation usually takes about an hour. After surgery, a catheter is inserted through the penis and into the bladder. It remains in place for about a day to help urine drain while the prostate heals. You can usually leave the hospital after 1 to 2 days and return to normal activities in 1 to 2 weeks.

You will probably have some blood in your urine after surgery.

Other possible side effects from TURP include infection and any risks that come with the type of anesthesia used.

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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.

Types Of Radical Prostatectomy

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. One is a traditional approach known as open prostatectomy. The other, more recent approach is minimally invasive. There are two minimally invasive procedures used in radical prostatectomy: laparoscopic prostatectomy and robot-assisted laparoscopic prostatectomy.

Open prostatectomy

In this traditional method of radical prostatectomy, the surgeon makes a vertical 8- to 10-inch incision below the belly button. Radical prostatectomy is performed through this incision. In rare cases, the incision is made in the perineum, the space between the scrotum and anus.

Laparoscopic prostatectomy

In laparoscopic prostatectomy, surgeons make several small incisions across the belly. Surgical tools and a camera are inserted through the incisions, and radical prostatectomy is performed from outside the body. The surgeon views the entire operation on a video screen.

Robot-assisted laparoscopic prostatectomy

Small incisions are made in the belly, as in regular laparoscopic prostatectomy. A surgeon controls an advanced robotic system of surgical tools from outside the body. A high-tech interface lets the surgeon use natural wrist movements and a 3-D screen during radical prostatectomy.

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Types Of Prostate Surgery

There are several ways of removing the prostate keyhole surgery either by hand or robot-assisted, and open surgery.

Although robot-assisted keyhole surgery is the newest technique, the most recent research suggests all three techniques are as good as each other for treating prostate cancer, as long as the surgeon is experienced. They also have similar rates of side effects.

The advantages of keyhole surgery, both by hand and robot-assisted, are that you are likely to lose less blood, have less pain, spend less time in hospital, and heal more quickly than with open surgery.

Keyhole surgery

Keyhole surgery .

  • Robot-assisted keyhole surgery Your surgeon makes five or six small cuts in your lower abdomen and a slightly bigger cut near your belly button, and removes the prostate using special surgical tools. These include a thin, lighted tube with a small camera on the tip. The image will appear on a screen so the surgeon can see what theyre doing. Your surgeon controls the tools from a console in the operating room via four or five robotic arms. Although its called robot-assisted, its still a surgeon who does the operation. You may hear the equipment called the da VinciĀ® Robot.
  • Keyhole surgery by hand As with robot-assisted keyhole surgery, the surgeon will make four or five small cuts in your abdomen. But they will hold the surgical tools in their hands, rather than using robotic arms.

Open surgery

The Prostate Gland And Prostate Cancer

What Should I Expect After Prostate Cancer Surgery?

The prostate gland is a male reproductive organ that sits around the urethra, the outlet tube for urine, just below the bladder. The glands surface is usually smooth and regular. The prostate is about the size of a walnut.

The prostate gland releases a clear fluid into the urethra that represents up to a third of the semen during ejaculation. One of the functions of the fluid is to carry the sperm and help sperm movement.

The prostate also helps the drive of semen during ejaculation.

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What Changes Do I Need To Make To My Diet

Discuss your post-surgery diet with your doctor as you will probably want to avoid or at least minimize issues such as constipation. The lack of exercise, the medication, even the stress, might affect your bowel functions. Your diet will be focused on eating more vegetables, fruits, grains and avoiding meat, especially the red one, pasta, alcohol, fast-food, sugar and processed desserts.

Ask Your Doctor About Solutions

Patients should not be shy about discussing intimacy issues with their doctor. He or she may be able to prescribe medications to help. Certain medicationssuch as sildenafil , tadalafil or vardenafil are typically tried first. But these drugs may not help men achieve an erection if the nerves responsible are not healthy. In fact, the medications only work for a small percentage of men in the first few months after surgery, according to a 2017 study published in the International Journal of Sexual Health.

Besides oral medications for erectile dysfunction, there are other options available to men with ED after prostate cancer treatment, says Dr. Shelfo. These include penile injection therapy, which involves injecting a small amount of medication directly into the base of the penis. That has helped many men achieve erections. Another option is an intraurethral suppository of medication, an external vacuum erection device, or surgery may be performed to implant a penile prosthesis.

While regaining erectile function is not possible for all men treated for prostate cancer, it is important to remember that an erection is just one aspect of a satisfying sex life. Intimacy is another major component, one that may become more important as sexual relationships become more difficult after cancer treatment.

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Histology Results And Follow

You will have an appointment at 4 weeks post-operation. Between your operation and this date, your prostate will have been sent to a laboratory where it is thoroughly inspected to produce a final report on the precise details of your cancer. This is called a histology report. During this appointment you will be given the histology results, detailing the final Gleason grade and stage of tumour, which is very important in determining your prognosis and the probability of the need for additional treatment, such as radiotherapy.

Questions To Ask Your Doctor Or Nurse

What to expect After Brachytherapy For Prostate most cancers

You may find it helpful to keep a note of any questions you have to take to your next appointment.

  • What type of surgery do you recommend for me and why?
  • What type of surgery do you recommend for me? Will you try to do nerve-sparing surgery?
  • How many of these operations have you done and how many do you do each year?
  • Can I see the results of radical prostatectomies youve carried out?
  • What pain relief will I get after the operation?
  • How and when will we know whether the operation has removed all of the cancer?
  • How often will my PSA level be checked?
  • What is the chance of needing further treatment after surgery?
  • What is the risk of having urinary problems or erection problems and what support can you offer me?

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Sexuality And Feeling Good About Your Body

Prostate cancer treatment can often affect sexual function. Learning to be comfortable with your body during and after prostate cancer treatment is a personal journey, one that is different for everyone. Information and support can help you cope with these changes over time. Learn more in Sex and the Man With Cancer.

Recent Findings About Regaining Potency After Radical Prostatectomy

It is important to remember that regaining erectile function takes time after radical robotic prostatectomy. Most studies in the literature use endpoints of 18-36 months after prostate cancer surgery. Nerve tissue can be easily damaged during robotic prostatectomy, regardless of the skill of the surgeon, and takes a long time to regenerate. It is believed that early postoperative medical therapy can aid an earlier return to potency.

Dr. Ahlering, a physician with UC Irvine Medical in Orange County, CA. has pioneered the use of electrocautery-free preservation of the neurovascular bundles which are essential for the return of potency after prostate surgery. A recent study by Dr. Patrick Walsh and associates at John Hopkins has shown that mono and bipolar cautery near the potency nerves severely impact the erectile function of dogs. Mono and bipolar cautery are routinely used by many institutions to limit the bleeding during surgery by heat-sealing or cauterizing the bleeding vessels.

The nerves for potency are intertwined with a bundle of blood vessels, which must be controlled during prostate cancer surgery to prevent large blood losses. Thus to preserve the nerves of potency, a surgeon also must prevent the bleeding of these vessels also. Cautery is considered a standard method of sealing the blood vessels, allowing the nerve bundles to now be properly visualized.

For comparison we show the standard data on open prostatectomy potency :

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When To Call Your Doctor Or Nurse

Its important to tell your doctor or nurse if:

  • your bladder feels full or your catheter isnt draining urine
  • your catheter leaks or falls out
  • your urine contains blood clots, turns cloudy, dark or red, or has a strong smell
  • your wound area or the tip of your penis becomes red, swollen or painful
  • you have a fever
  • you feel sick or vomit
  • you get cramps in your stomach area that will not go away
  • you get pain or swelling in the muscles in your lower legs.

Your doctor or nurse will let you know if you should go to the hospital.

How Fast Will I Become Totally Continent After Prostate Surgery

Incontinence After Prostate Cancer Surgery Explained

During surgery for prostate cancer, the urethra is also affected and, depending on the experience of the surgeon, more or less of the continence function will be preserved. Due to the high precision of robotic surgery, the patient will have a catheter for roughly one week and the trauma to the urinary function will be minimum.

The discomfort that patients feel during this time is minimum, but you should expect the removal to make you feel uneasy. The catheter will be removed during a visit to your doctor, so do not try to do this at home, as it could cause infections. The degree of which the urinary function will be affected depends on how normal the function was before surgery, age and weight.

It is worth noting that most men will experience some degree of incontinence after prostate surgery, but control can be regained within several weeks or months to a year.

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What To Expect After Prostate Removal

Prostate removal is an effective treatment option for prostate cancer. A radical prostatectomy, which removes the entire prostate gland as well as some surrounding tissue, takes a few hours to complete.

Here are three things you can expect after your prostate is removed.

  • Gradual Recovery
  • Prostate removal is major surgery, so expect some soreness and pain. Youll receive IV pain medications at first, and your doctor may prescribe you pain medication to use at home. You will also have a urinary catheter in place for about the first week, which you might find uncomfortable.

    Most patients are up and moving the day of surgery and go home the following day. Although you will need to rest and gradually resume physical activity, urologist Mina Fam, M.D., emphasizes the importance of movement. I want patients up and walking the same day of surgery because any kind of cancer surgery has a risk for blood clotting, Dr. Fam says. I encourage patients to keep walking during their recovery.

    Expect it to take about four weeks to start feeling back to your normal self if your surgery was done robotically and up to six weeks with a traditional open approach.

  • Changes in Your Sex Life
  • Treatment options include:

    • Counseling

    Work with your doctor to find a treatment that is right for you.

    Another change to expect in your sex life is that, because the seminal vesicles are removed during surgery, you wont ejaculate semen during orgasm.

  • Bladder Problems
    • Medication

    The Risk Of Your Cancer Coming Back

    For many men with localised or locally advanced prostate cancer, treatment is successful and gets rid of the cancer. But sometimes not all the cancer is successfully treated, or the cancer may have been more advanced than first thought. If this happens, your cancer may come back this is known as recurrent prostate cancer.

    One of the aims of your follow-up appointments is to check for any signs that your cancer has come back. If your cancer does come back, there are treatments available that aim to control or get rid of the cancer.

    Your doctor cant say for certain whether your cancer will come back. They can only tell you how likely this is.

    When your prostate cancer was first diagnosed, your doctor may have talked about the risk of your cancer coming back after treatment. To work out your risk, your doctor will have looked at your PSA level, your Gleason score and the stage of your cancer. If your prostate has been removed, it will have been sent to a laboratory for further tests. This can give a better idea of how aggressive the cancer was and whether it is likely to spread. If you dont know these details, ask your doctor or nurse.

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    Side Effects From Radiation

    Urinary symptoms from radiation treatment for prostate cancer are different from those caused by prostate surgery. “It’s more like a urinary tract infection-increased urgency and frequency, and men may some have bleeding or pain when they urinate,” Calvaresi said. These problems often go away once treatment is complete.

    Radiation also may cause bowel changes, such as constipation, loose stools or both. These can be managed by over-the-counter medication. Men may also see some blood in their stool during treatment-if so, let your health care provider know about this.

    Men undergoing radiation are likely to have ED, but not immediately. “It slowly sets in after radiation treatment,” Calvaresi said. Treatments for radiation-related ED are the same as ED caused by prostate cancer surgery.

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