Prostate cancer is the second most common type of malignancy diagnosed in men in the United States. In men over fifty, it is actually the most common form. When a growth on the prostate becomes malignant, a prostatectomy is often in order. According to healthatoz.com, a prostatectomy is “the surgical removal of part of the prostate gland, or all of the prostate.” There are several different approaches doctors may utilize when a prostatectomy is in order. The first, Radical Retropubic Prostatectomy, is a procedure in which the surgeon cuts an incision in the lower abdomen in order to reach the prostate. This procedure, while effective, has been associated with nerve damage which results in impotency in many patients. Potency-Sparing Radical Prostatectomy was devised in order to preserve sexual potency, and is successful in doing so with 75% of patients.
The second approach is called Radical Perineal Prostatectomy. With this procedure, the surgeon cuts into the perineum (the space between the rectum and the scrotum) and removes the lymph nodes via that incision. However, despite being equal in its effectiveness, this technique is utilized less often than Radical Retropubic Prostatectomy because of the resulting nerve damage, which leaves the patient impotent. While RPP is considered to be less invasive (and less visible, cosmetically speaking) than RRP, it is generally only indicated if the need to preserve erectile function does not exist, or if a faster procedure is necessary to accommodate the patient’s healthcare needs.
A less invasive third method is the Transurethral Prostatectomy. This procedure is generally faster than the other two, requiring about a half hour to an hour rather than two to three hours. The procedure involves the insertion of a metal tube into the urethra in order to remove prostate tissue. Recovery time may also be quicker, but post-surgical hospitalization is still typically required. This technique is indicated when the inhibiting mass is benign (non-cancerous).
A fourth option does exist. Cryosurgery is a technique in which the cancer cells in and around the prostate are frozen. It is a relatively new procedure, but has recently been approved for treatment in most patients. However, it is not the same as a prostatectomy, as it does not involve removal of the actual glands themselves.
When a prostatectomy is in order, regardless of the chosen method, pre-surgical measures are taken to insure the safest and most effective procedure possible. This may include discontinuing use of aspirin or ibuprofen, an increase in fiber and water intake to flush the bowels, and sometimes, the use of a precautionary antibiotic. The doctor will consult with the patient to decide which steps are necessary and will most likely restrict or eliminate food intake just prior to surgery.
There are several possible lasting side effects that can occur after a prostatectomy has been performed. Erectile dysfunction is a risk, especially if cancer has spread to the nerves surrounding the prostate. Eventually, most men are able to regain erectile function, perhaps as many as 76% of men younger than sixty (according to webmd.com). Recovery of erectile function depends upon several factors, including age, previous erectile function, and extent of nerve damage.
Other possible effects include urinary incontinence and damage to the urethra and rectum. Blood clots and infection are also a risk, as they are with most major surgeries. Incontinence occurs in approximately 50% of prostatectomy patients, with varying recovery periods. Additional treatment may be required if leakage lasts more than a year.
During the post-surgical inpatient period, several recovery techniques may be utilized. These can include (but are not limited to) drains to remove fluid from the incision site, the use of oxygen via a mask or nasal tubes, antibiotics and pain medications, and several drugless pain management methods, such as hugging a pillow against the abdomen or deep breathing.
The outpatient recovery for a prostatectomy will generally require continued medical intervention, as well as a schedule of follow up visits and tests. In most cases, a catheter will be inserted and used to drain the bladder of urine for one to three weeks. The presence of a catheter typically does not require an extended hospital stay and can be cared for at home under the instruction of the attending surgeon. Physicals, biopsies of any suspicious tissue, periodic rectal exams, and prostate-specific antigen tests may also be required.
Once a patient has left the security of the hospital, it is important to keep an eye out for possible complications or problems. The hospital will provide more detailed instructions on when to call a doctor, but a few examples of situations which require immediate medical attention may include chest pain or shaking chills. The presence of bright red urine, fever, or rash warrants a phone call to the doctor.
When selecting a surgeon to perform a prostatectomy, there are several factors to take into account. It is to the advantage of the patient to research the history and experience of a few surgeons before making a final decision. In addition to doing a background check for any lawsuits or other legal proceedings involving malpractice or injury, it is also wise to become familiar with the surgeon’s experience with the above stated techniques, their dedication to continuing education in the field of prostate removal, and their success rate. It is important to choose a surgeon with a solid background and history of success not only overall, but with the particular method that will be performed. A good bedside manner is also a plus!
A prostatectomy is generally indicated only if a candidate is in good overall health, and is expected to live more than ten years after the procedure. One in five men will need to have a repeat procedure within ten years to remove new tumors and tissue. Any radical prostatectomy is a major surgical procedure, so it is important to consult with a doctor about any questions or concerns before the procedure takes place. Further information and resources can be found at www.prostate-cancer-institute.org
