Radical prostatectomy is a surgical procedure done to remove entire prostate gland along with some surrounding tissue from the body. The prostatectomy is done to remove the cancer in prostate gland and prevent the spreading of cancer to other body parts. The process may be done through open surgery or laparoscopic surgery, which may be manual or robot-assisted, where it’s called robot assisted prostatectomy.
Prostate gland is a muscular gland surrounding part of urethra, the tube which carries urine and sperm out of the male body. It is an essential part of male reproductive system. The prostate gland produces the seminal fluid, the milky substance that carries the sperm.
Radical prostatectomy is done if tests show that the cancer has not yet spread much outside the prostate, i.e. if the cancer is still in stage I or II.
Radical prostatectomy can also be used as a treatment for urinary obstruction in men with stag III prostatic cancer. Transurethral resection of prostate, however, is a more commonly used treatment for such patients. Also, radical prostatectomy does not treat advanced prostatic cancer, but only helps to treat the symptoms.
In open radical prostatectomy operation, the surgeon makes an incision in lower abdomen to reach the prostate gland. Depending upon the case, the incision may be made in lower belly, called retropubic approach, or in perineum between the scrotum and the anus, called perineal approach. In the retropubic approach, the doctors usually remove the lymph nodes in the area as well to evaluate them for cancer. The lymph nodes are removed through a separate incision. Although the surgeon may not remove the lymph nodes if they are believed to be free of cancer according to cancer’s grade and PSA test results. However the recovery time required for retropubic approach is comparatively longer than that of perineal approach.
Another way to get rid of prostatic cancer through radical prostatectomy is laparoscopic surgery, in which several small incisions are made in the belly. A laparoscope is inserted into one of the incisions, which is a small lighted instrument. The prostate is then removed using special instruments via other incisions. This process is called manual laparoscopic surgery. Nowadays, patients have the option of robot assisted laparoscopic surgery, which is exactly like its manual counterpart, except that it uses robotic arms which mimic a surgeon’s hand motions with extreme finesse and precision. Robot assisted laparoscopy radical prostatectomy usually requires specially trained doctors.
The main aim of either open or laparoscopic surgery is removal of prostatic cancer from the body. Sometimes it may require removal of entire prostate gland as well as tissues surrounding the gland, along with a set of nerves which affects a male’s ability to get an erection. This setback can be avoided through the use of nerve-sparing technique, which requires extremely precise cutting around the nerves in order to remove all the tumors and keep the nerves intact so as not to affect men’s ability to get an erection.
Radical prostatectomy usually requires use of general anesthesia and a period of hospital stay of up to 3-4 days afterwards. A catheter, which is a small, flexible tube, is usually left in the patients’ bladder to drain the urine for up to 3 weeks. Patients are provided with a general set of instructions to help them take care of the catheter for the required period. After the catheter is removed, bladder control can be somewhat poor, but this only lasts for a few weeks or months.
Radical prostatectomy is a very effective treatment for early stages of prostatic cancer. After radical prostatectomy operation, the cancer’s stage can be evaluated based on how far it had spread. If the radical prostatectomy operation successfully removes all the cancerous tumors, the PSA test scores will drop to almost zero. However, if the cancer is in advanced stages and has spread further beyond the prostate gland, the radical prostatectomy operation may only help relieve certain symptoms.
Although radical prostatectomy is an efficient treatment for early stages or localized prostate cancer, there are certain risks involved with radical prostatectomy. Erectile dysfunction is one of the serious side effects of radical prostatectomy. During the radical prostatectomy operation, the nerves that control men’s ability to get erection may get injured or even consciously removed in some cases. About half of the patients who had undergone radical prostatectomy regain the ability within some months or a year. Recovery depends upon various factors such as ability to have erection before the surgery, effect of radical prostatectomy on the nerves, and the patient’s age during the time of surgery. Medication like Prostacet for prostatic hyperplasia and Viagra, Cialis, or Levitra and some mechanical aids may prove helpful for patients with damaged nerves due to radical prostatectomy. The medicines may be more effective if intake was started soon after the surgery. Patients should consult with their doctors regarding the problem.
Urinary incontinence is another side effect which develops in almost half of the patients after undergoing radical prostatectomy. This may require urinary incontinence pads to prevent embarrassment due to occasional dribbling of urine. The side effect is more likely to develop after a year of the radical prostatectomy operation. During the surgery, the urethra is cut and then reconnected to the bladder. Therefore, chances of urinary incontinence are much lower if the radical prostatectomy operation is performed by a skilled surgeon. Treatment, however, may be necessary if the problem continues for longer than a year.
Radical prostatectomy is quite a major surgery, and carries general risks related to other operations like heart problems, allergic reactions to anesthesia used in surgery, blood clots, blood loss, and infections in the incision. Damage to urethra and rectum are also possible during the radical prostatectomy operation.
Radical prostatectomy should be opted after a considerable amount of personal thought over the procedure and how it may affect the patient’s overall health and quality of life. Age, medical conditions related to bowel or sexual function may affect the recovery after the radical prostatectomy operation. Patients may also be advised other options like active surveillance or radiation therapy to fight the cancer.
Care must always be taken to choose a highly skilled and experienced surgeon with a good success rate for the radical prostatectomy operation. Side effects like erectile dysfunction and urinary incontinence are much less likely to occur if the surgery is performed by a skilled surgeon. Robot assisted prostatectomy may also be a better options for younger patients with good health who need treatment for early stages of prostatic cancer.
Both the radical prostatectomy operation and radiation therapy may cause urinary incontinence or erectile dysfunction. The severity of both conditions depends upon the stage of cancer and what treatment is used, for instance, radiation therapy will most certainly cause some level of impotence, but radical prostatectomy performed by a skilled surgeon can prevent this.
Patients should keep in mind that although radical prostatectomy will remove the entire prostate gland, it is not possible to know ahead of time whether the cancer will be completely removed by the operation or not. Also, radical prostatectomy done when the cancer is localized removes all the tumors, yet follow ups are necessary to ensure early detection and subsequent treatment in case the cancer comes back. Follow up program of radical prostatectomy includes physical examinations, PSA tests, digital rectal exams, and in some cases, biopsies, if needed, to look for suspicious tissue growth.