Prostate Cancer Surgery
Prostate cancer (prostate adenocarcinoma) is a malignant neoplasm of pancreas that develops from cells of the glandular epithelium or connective tissue. Nowadays, prostate cancer (PC) is the most common type of cancer in men, after skin cancer. The risk increases with age and is highest after 65 years of age. In the early stages, the tumor does not go beyond the prostate and practically does not manifest itself in any way.
The first signs of prostate cancer appear as the tumor grows in mass, when it constricts the urethra and disrupts the normal flow of urine. Without treatment, the tumor can grow through the prostate capsule and metastasize to other organs.
Management of prostate cancer can be various from active surveillance to chemo or radiation therapy, brachytherapy, medical anti-androgen therapy and the most effective one – surgery.
The choice of methods for treating prostate cancer in men depends on the stage of the disease, the general physical condition and the characteristics of the individual patient. In the early stages, high-precision radiation therapy (external or internal, brachytherapy) can be used.
Radical prostatectomy is considered the gold standard in the treatment of prostate cancer. In some cases, hormone therapy may be required to slow tumor growth before prostate cancer surgery. Chemotherapy is used for the most severe forms of prostate cancer with metastasis to other organs.
The Gleason Score
is used to determine the aggressiveness of a prostate tumor. The less cancer cells are similar to normal (healthy) cells, the higher the Gleason score and the more aggressive prostate cancer.It often turns out that not all cancer cells in the prostate tissue have the same aggressiveness.
The morphologist examines under a microscope two of the most characteristic tissue samples taken from a prostate biopsy and assesses them on a 5-point scale, depending on the degree of differentiation. The most aggressive tumor cells are scored 5 points, the least aggressive ones get a minimum score of 1. The higher it is, the greater the threat posed by a poorly differentiated tumor.
Prostate Cancer Surgery
Radical prostatectomy – complete surgical removal of the prostate gland with seminal vesicles and regional lymph nodes is especially indicated as a therapeutic option if the tumor is confined to the prostate.
It’s the gold standard procedure for prostate cancer.Best candidates are patients under 70 years of age or older with ability to tolerate prostate cancer surgery and anesthesia. This operation is currently the most commonly used and very proven method. If the tumor has not gone beyond the connective capsule, then it is possible to defeat the disease in 100% of cases. But if the tumor has grown into neighboring organs, then it can also be removed, but the prognosis for recovery worsens. Chemotherapy or radiotherapy may additionally be required.
Your doctor will explain the surgery and you’ll be asked to sign the consent form of procedure.You will need to fast approximately 8 hours before prostate cancer surgery IV line will be inserted, by which you will receive antibiotics to decrease the risk of surgical infection, pain medications, sedativesYou will get general, spinal or epidural anesthesia, your doctor will make the decision depending on your lab work and requests.
Types of radical prostatectomy
Approaches can be either supra-pubic (retro-pubic) or a perineal incision (through skin between rectum and scrotum). Supra-pubic approach is considered to be most commonly used. Perineal incisions are not frequently used since risk of damaging nerves is higher with this approach and this way it’s impossible to remove lymph nodes.
With an open surgical approach, the prostate is removed most of the time through a small incision in the lower abdomen – iliac region. The intervention is performed using microsurgical techniques under optical magnification.
Surgeon inserts long instruments through several small incisions in the abdominal wall. One of the instruments has a small video camera on the end, which lets the surgeon see inside the body to then remove prostate tissue and surrounding lymph nodes as needed.
Laparoscopic approach has some benefits compared to open approach, like less blood loss and pain, shorter hospital stay and less scar tissue.
Recently, the robot-assisted laparoscopic approach is receiving popularity as it minimizes blood loss and hospital stay. Modern clinics offer treatment with a special robotic surgeon “Da Vinci”. The doctor controls all actions of the robotic system, which relieves the body of the tumor with high precision.
The operation is performed through small punctures, which then heal quickly. New technologies make it possible to reduce the risk of complications to a minimum. Side effects such as urinary incontinence and impotence are avoided. Although it has shown no benefit in decreasing mortality or morbidity.
Variant: salvage prostatectomy
It’s the radical prostatectomy done after unsuccessful primary radiation therapyQuite challenging procedure with slightly higher risk of complications due to scarred and damaged tissue caused by prior radiation.
You will be taken to recovery room. Post-surgical recovery time spent in hospital is about 2 days where you will be closely monitored and will receive antibiotics, pain medications as required.
While you are still under anesthesia, a catheter -thin, flexible tube, will be put to help drain your bladder. The catheter usually stays in place for 2 or 3 weeks while you heal. You will be able to urinate on your own after removing the catheter.
Radical prostatectomy can take from 90 minutes to 4 hours, time depends on anatomy, type of cancer invasion and of course surgeon’s experience.
The cost of radical prostatectomy ranges from 15,000$ to 60,000$ prices change according to the clinic, surgeon experience and method of prostate cancer surgery.
Urinary incontinence – inability to control urine flow in about 5 -10%. Good news is it can improve overtime, in approximately 1 year.
Bladder neck contracture or urethral stricture – 8-20%
Erectile dysfunction (Impotence) is known to be the most common complication of this procedure encountered in about 30-100% of cases, although it’s heavily dependent on age and current function. Sexual function recovery may take up to 2 years.
Sterility (Infertility) – Radical prostatectomy removes vas deferens leading to infertility.
Lymphedema – accumulation of lymph in soft tissues, causing swelling. This complication is quite rare and is manageable with physical therapy
Rectal injury – can be seen in just 1-2%Other procedures:Surgical castration – Another type of is a type of anti-androgen therapy procedure that can be done to manage the symptoms and slow progression of prostatic cancer. A bilateral orchiectomy done in situations which require to decrease testosterone levels immediately.
Transurethral resection of the prostate (TURP) – This procedure is mostly used to treat men with benign enlargement of the prostate called benign prostatic hyperplasia (BPH). Although it’s also sometimes used in men with advanced prostate cancer to help relieve symptoms, such as trouble urinating.
Urologist removes the part of prostate that surrounds the urethra using resectoscope – thin metal tube containing a light, which is inserted into the tip of penis and extended through urethra and into the prostate tissue. The skin is left intact with this procedure.
This procedure can only relieve some of the discomforting symptoms of pancreatic cancer and not cure it.
Cryotherapy – even though it’s sometimes called cryosurgery it’s not exactly a surgery, but a procedure which destructs the prostate cells by freezing them with cryoprobes, followed by thawing. Although not commonly used as a first-line treatment type, It may be an option for those with low risk early-stage prostate cancer who are not candidates for prostate cancer surgery or can’t receive radiation therapy.