Radical prostatectomy is major surgery that removes the entire prostate gland plus some surrounding tissue. The surgery is performed to remove the cancer entirely as well as to prevent its spread to other parts of the body. The surgeon may decide that the pelvic lymph nodes to be sampled for a biopsy. Radical prostatectomy is performed under general or regional anesthesia.
This surgery can be radical retropubic prostatectomy, radical perineal prostatectomy, laparoscopic radical prostatectomy (LRP) or transurethral resection of the prostate (TURP).
In retropubic prostatectomy, the surgeon makes an incision in the lower abdomen to remove the prostate gland. Lymph nodes around the prostate might also be removed depending on whether the cancer has spread to these parts.
In perineal prostatectomy, the incision is made in the perineum or the skin between anus and scrotum. This procedure is use less often because the lymph nodes cannot be removed and there is a high probability that the nerves will be affected.
LRP, on the other hand, involves the use of several smaller incisions and specialized instruments. This highly complex procedure is known for its high precision and control. In the hands of experienced surgeons, it becomes an advantageous option compared with retropubic and perineal prostatectomy.
TURP, meanwhile, makes use of an instrument called a resectoscope which is passed through the end of the penis into the urethra at the level of the prostate. The electricity that passes through the instrument cuts or vaporizes the issue in the prostate. TURP is done to relieve symptoms and is also used for benign prostatic hyperplasia.
Risks of radical prostatectomy
The risks after this procedure are similar to those of any major surgery. They may include:
Impotence
Heart attack
Stroke
Blood clots in the legs
Infection at the incision site
Post-operative bleeding
Death (very rare)
Recovery time for radical prostatectomy
Since a radical prostatectomy is major surgery, patients may require blood transfusion.
After operation, patients typically need 2-4 days of hospitalization. Full recovery can take up to 12 weeks.
Side effects of radical prostatectomy
A traditional radical prostatectomy is undertaken using wide margins around the prostate,
damaging the nerves which control the blood supply to the penis. By consequence, among side effects,
impotence is nearly guaranteed (51 - 96% impotence rates have been shown). Incontinence is also a very realistic side effects.
Conclusion related to selection criteria
Because of this radical prostatectomy's are not popular among possible prostate cancer treatment options, and usually only seen as a last resort.
It is recommended only for men in good general condition who can withstand long anesthesia and have a life expectancy of ten years or more.
Success and effectiveness of radical prostatectomy
Radical prostatectomy's have the highest success rate among all prostate cancer treatment options, due to the fact that it calls for the complete removal of the prostate.
Success rates for a radical prostatectomy can range from 30 - 98%. Studies have shown success rates between 76 - 98% for low-risk disease;
60 - 76% for moderate risks disease; and 30 - 76% for high risks disease.
The experience of the surgeon performing the surgery is an important fact, i.e.
surgeons have greater success and lower complications rates if they routinely perform the procedure.
Traditional or robotic prostate surgery? Men diagnosed with prostate cancer in their 40s and 50s are often steered toward surgery (called a radical
prostatectomy), since it's thought to offer the best chance for long-term survival. What's more, removing the
prostate and examining it in a lab is the only way to know for sure how much cancer was there and how likely
it is to return.
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Treatments after prostate surgery reported in the Journal of Urology Although primary prostate surgery or radiotherapy is successful in many cases of prostate cancer, some patients
will suffer a recurrence of the disease, which is most often first detected by a measurable PSA blood test. This
so-called biochemical recurrence affects 30% to 40% of patients after surgery.
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Satisfaction and regret after radical prostatectomy procedures studied New study published in European Urology
have shown that approximately 16% of patients with localised prostate cancer regret their treatment choice.
European Urology (http://www.europeanurology.com), the official journal of the European Association of Urology,
will be publishing an article
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Pelvic Floor Exercises For Men Facing Prostate Surgery: The Sooner The Better Men about to undergo prostate cancer surgery should begin a program of pelvic floor muscle exercises (also
known as kegel exercises) before surgery, and continue afterwards. That’s the new recommendation from the Expert
Committees on the Adult Conservative Management of Incontinence at the International Consultation on Incontinence,
Paris, 2008.
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Sexual Life After Prostate Removal One of the most feared side effects of therapy for prostate cancer is the impact on sexual health. According to
National Cancer Institute in US, about 219.000 men have been diagnosed prostate cancer every year and almost a
half of those men had prostate removal.
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This surgery can be radical retropubic prostatectomy, radical perineal prostatectomy, laparoscopic radical prostatectomy (LRP) or transurethral resection of the prostate (TURP).